Combination of elevated exhaled nitric oxide and serum eosinophil cationic protein identifies asthma patients at risk for exacerbation

Abstract BackgroundTests to identify reversible airflow limitation are important in asthma diagnosis, but they are time-consuming and may be difficult for patients to cooperate. We aim to evaluate the predictive value of fractional exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) count in asthma diagnosis, and to distinguish patients who could avoid reversibility testing.MethodsWe screened 7463 suspected asthma cases between January 2014 and December 2019 in Chongqing, China, and identified 2349 patients with complete FeNO, B-Eos count, and spirometry data. Of these, 824 were diagnosed with asthma via a positive bronchial-provocation or bronchodilation test.ResultsWhen FeNO and B-Eos counts were used in combination, the area under the receiver operating characteristic curve (AUC) for diagnosing asthma increased (0.768 vs. 0.745 or 0.728; both P < 0.001). The odds ratio for having asthma increased progressively with a gradual increase in FeNO or B-Eos count (both P < 0.001). Further analysis of in-series combinations of different threshold values for these biomarkers indicated that moderately elevated biomarker levels (FeNO > 40 ppb and B-Eos > 300 cells/μl) support a diagnosis of asthma because diagnostic specificity was > 95% and the positive likelihood ratio (PLR) was > 10. This conclusion was verified when selecting the data from 2017 to 2019 as the verification cohort.ConclusionThe combination of FeNO and B-Eos count can improve diagnostic efficacy for asthma. Patients with moderately elevated biomarkers (FeNO > 40 ppb and B-Eos > 300 cells/μl) could be diagnosed with asthma.

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The Utility of Serum IL-1β and CRP Together with Fractional Exhaled Nitric Oxide in the Diagnosis of Asthma in Adults

NeuroQuantology ◽

10.14704/nq.2021.19.8.nq21122 ◽

2021 ◽

Vol 19 (8) ◽

pp. 119-124

Author(s):

Hayder Abdul-Amir Makki Al-Hindy ◽

Ali Jihad Hemid Al-Athari ◽

Mazin J. Mousa ◽

Safa Jihad Hameed ◽

Suhad Hafidh Obeed

Keyword(s):

Nitric Oxide ◽

Sensitivity And Specificity ◽

Bronchial Asthma ◽

High Sensitivity ◽

Exhaled Nitric Oxide ◽

Fractional Exhaled Nitric Oxide ◽

Asthmatic Patients ◽

Significant Difference ◽

Asthma Patients ◽

Hs Crp

Background: Bronchial asthma (BrA), recognized lately as an umbrella, covers various subtypes rather than only one disease. Asthma is a chronic inflammation of the airways, in which cytokines could play a crucial role in its pathogenesis. Hence, labors to progress noninvasive markers for asthma had centered through this era. Presently, the fractional exhaled nitric oxide (FeNO), serum C-reactive protein (CRP), and interleukin levels are emerging analytical biomarkers in this field. FeNO is a noninvasive and practical tool even in mild asthma. This study aimed to evaluate the utility of serum IL-1β and CRP together with fractional exhaled nitric oxide in the diagnosis of adult bronchial asthma. Method: The study was a case control, including 150-patients and 100-healthy controls. FeNO tests, measurements of plasma levels IL-1β and HS-CRP had undertaken for all the participants. The statistical data had examined by SPSS (V/27) for Windows. Descriptive data of the variables had compatibly used. A significance lower than or identical to 0.05 had intended. ROC curve examination of FeNO tests, IL-1β, and HS-CRP, to predict asthma from healthy control had applied. Results: there was a significant difference in the FeNo test, HS-CRP levels, and BMI, while no significant difference in all other variables between the groups. The FeNo results correlate positively, though not significantly, with the levels of IL-1β in asthmatic patients (> 0.05). There was a nonsignificant negative correlation between the FeNo results with the level of HSCRP. The accuracy, sensitivity, and specificity of the IL-1β to distinguish asthma were 68.6% and 58% at 95% CI [0.41-0.745], respectively, which was not significant (p>0.05). However, ROC analysis of HS-CRP revealed predictability for asthma patients (p-0.000), with higher accuracy, sensitivity, and specificity: 89.9%, and 68.1% at 95% CI [0.820-0.979], respectively. The FeNo tests revealed highly significant (0.000), high sensitivity, and specific (91% for both) with high 95% CI [0.938-1.000] predictability for asthma. Conclusion: The utility of circulating HS-CRP is more valuable than IL-1β when combined with fractional exhaled nitric oxide in the diagnosis of asthma. Novel biomarkers could improve the precision of this field.

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Dose-Response Relationship and Reproducibility of the Fall in Exhaled Nitric Oxide After Inhaled Beclomethasone Dipropionate Therapy in Asthma Patients

CHEST Journal ◽

10.1378/chest.119.5.1322 ◽

2001 ◽

Vol 119 (5) ◽

pp. 1322-1328 ◽

Cited By ~ 128

Author(s):

Philip E. Silkoff ◽

Patricia McClean ◽

Michael Spino ◽

Lu Ann Erlich ◽

Arthur S. Slutsky ◽

...

Keyword(s):

Nitric Oxide ◽

Dose Response ◽

Beclomethasone Dipropionate ◽

Exhaled Nitric Oxide ◽

Response Relationship ◽

Dose Response Relationship ◽

Asthma Patients

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Exhaled nitric oxide in overweight and obese asthma patients compared to normal weight asthmatic patients

10.1183/13993003.congress-2019.pa2611 ◽

2019 ◽

Author(s):

Khalil Ansarin ◽

Ansiyeh Seyedrezazadeh

Keyword(s):

Nitric Oxide ◽

Exhaled Nitric Oxide ◽

Normal Weight ◽

Asthmatic Patients ◽

Asthma Patients

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Allergen exposure modifies the relation of sensitization to fraction of exhaled nitric oxide levels in children at risk for allergy and asthma

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2011.01.066 ◽

2011 ◽

Vol 127 (5) ◽

pp. 1165-1172.e5 ◽

Cited By ~ 32

Author(s):

Joanne E. Sordillo ◽

Tara Webb ◽

Doris Kwan ◽

Jimmy Kamel ◽

Elaine Hoffman ◽

...

Keyword(s):

Nitric Oxide ◽

At Risk ◽

Allergen Exposure ◽

Exhaled Nitric Oxide ◽

Children At Risk ◽

Allergy And Asthma

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Lung function decline in asthma patients with elevated bronchial CD8, CD4 and CD3 cells

European Respiratory Journal ◽

10.1183/13993003.01525-2015 ◽

2016 ◽

Vol 48 (2) ◽

pp. 393-402 ◽

Cited By ~ 22

Author(s):

Irene den Otter ◽

Luuk N.A. Willems ◽

Annemarie van Schadewijk ◽

Simone van Wijngaarden ◽

Kirsten Janssen ◽

...

Keyword(s):

Lung Function ◽

Granzyme B ◽

Eosinophil Cationic Protein ◽

Risk Groups ◽

Forced Expiratory Volume ◽

Lung Function Decline ◽

Cationic Protein ◽

Asthmatic Patients ◽

Asthma Patients

Which inflammatory markers in the bronchial mucosa of asthma patients are associated with decline of lung function during 14 years of prospective follow-up?To address this question, 19 mild-to-moderate, atopic asthmatic patients underwent spirometry and bronchoscopy at baseline and after 14 years of follow-up (t=14). Baseline bronchial biopsies were analysed for reticular layer thickness, eosinophil cationic protein (EG2), mast cell tryptase (AA1), CD3, CD4 and CD8. Follow-up biopsies were stained for EG2, AA1, neutrophil elastase, CD3, CD4, CD8, CD20, granzyme B, CD68, DC-SIGN, Ki67 and mucins.Decline in forced expiratory volume in 1 s (FEV1) % predicted was highest in patients with high CD8 (p=0.01, both pre- and post-bronchodilator) or high CD4 counts at baseline (p=0.04 pre-bronchodilator, p=0.03 post-bronchodilator). Patients with high CD8, CD3 or granzyme B counts at t=14 also exhibited faster decline in FEV1 (p=0.00 CD8 pre-bronchodilator, p=0.04 CD8 post-bronchodilator, p=0.01 granzyme B pre-bronchodilator, and p<0.01 CD3 pre-bronchodilator).Long-term lung function decline in asthma is associated with elevation of bronchial CD8 and CD4 at baseline, and CD8, CD3 and granzyme B at follow-up. This suggests that high-risk groups can be identified on the basis of inflammatory phenotypes.

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