scholarly journals Diagnostic possibility of the combination of exhaled nitric oxide and blood eosinophil count for eosinophilic asthma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiang-Hua Li ◽  
Rui Han ◽  
Yu-Bo Wang ◽  
Min Cheng ◽  
Heng-Yi Chen ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Roc Curve ◽  
Positive Likelihood Ratio ◽  
Exhaled Nitric Oxide ◽  
Airflow Limitation ◽  
Validation Dataset ◽  
Trend Test ◽  
Blood Eosinophil ◽  
Asthma Patients ◽  
Objective Tests

Abstract Background Tests to identify reversible airflow limitation are important in asthma diagnosis, but they are time-consuming and it may be difficult for patients to cooperate. We aimed to evaluate whether the combination of fractional exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) can be used to distinguish some asthma patients who could avoid objective tests. Methods We conducted a retrospective cohort study on 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. Asthma was diagnosed by clinicians by the criteria of recurrent respiratory symptoms and a positive bronchial-provocation or bronchodilation test (BPT, BPD). We evaluated the diagnostic accuracy of FeNO or B-Eos alone or both in combination for asthma using receiver operating characteristic (ROC) curve analysis. Results In this study, 824 patients were diagnosed with asthma. When FeNO and B-Eos counts were used in combination, the area under the ROC curve (AUC) for diagnosing asthma increased slightly (0.768 vs. 0.745 [FeNO] or 0.728 [B-Eos]; 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; assessed using the Cochran–Armitage trend test). 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 2017–2019 data as the internal validation dataset. Conclusion FeNO or B-Eos count alone is insufficient to accurately diagnose asthma. Patients with moderately elevated biomarkers (FeNO > 40 ppb and B-Eos > 300 cells/μl) could be diagnosed with asthma and avoid objective tests when such tests are not feasible.

scholarly journals The efficacy of the combination of exhaled nitric oxide and blood eosinophil count in the diagnosis of asthma in China

2020 ◽  
Author(s):  
Jiang-hua Li ◽  
Rui Han ◽  
Yu-bo Wang ◽  
Min Cheng ◽  
Heng-yi Chen ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Exhaled Nitric Oxide ◽  
Airflow Limitation ◽  
Blood Eosinophil ◽  
Asthma Diagnosis ◽  
Diagnostic Efficacy ◽  
Asthma Patients ◽  
In Series

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.

scholarly journals Diagnosing persistent blood eosinophilia in asthma with single blood eosinophil or exhaled nitric oxide level

2018 ◽  
Vol 141 ◽  
pp. 81-86 ◽  
Author(s):  
Hanneke Coumou ◽  
Guus A. Westerhof ◽  
Selma B. de Nijs ◽  
Marijke Amelink ◽  
Elisabeth H. Bel
Keyword(s):  
Nitric Oxide ◽  
Exhaled Nitric Oxide ◽  
Blood Eosinophil ◽  
Blood Eosinophilia ◽  
Nitric Oxide Level

scholarly journals Clinical and Economic Consequences of Switching From Omalizumab to Mepolizumab in Uncontrolled Severe Eosinophilic Asthma: an Observational Retrospective Study

2020 ◽  
Author(s):  
Giovanna Elisiana Carpagnano ◽  
Emanuela Resta ◽  
Massimiliano Povero ◽  
Corrado Pelaia ◽  
Mariella D'Amato ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Asthma Control ◽  
Exhaled Nitric Oxide ◽  
Blood Eosinophil ◽  
Fractional Exhaled Nitric Oxide ◽  
Eosinophilic Asthma ◽  
Exacerbation Rate ◽  
Serum Ige ◽  
Severe Eosinophilic Asthma ◽  
Oral Corticosteroids

Abstract Background: Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids, which worsen patients’ health and increase healthcare spending. The aim of this study was to assess the clinical and economic impact of switching from omalizumab to mepolizumab in patients eligible for both biologics, but not optimally controlled by omalizumab.Methods: We retrospectively enrolled uncontrolled severe asthmatic patients, referred to seven asthma clinics in Italy, who switched from omalizumab to mepolizumab during the last two years. Clinical, functional, and laboratory information included blood eosinophil count, asthma control test, spirometry, serum IgE, fractional exhaled nitric oxide, oral corticosteroids intake, use of controller and rescue drugs, exacerbations/hospitalizations, visits and diagnostic exams. Within the perspective of Italian National Health System, a pre- and post-mepolizumab 12-month standardized total cost per patient was calculated.Results: 33 patients were enrolled: 5 males and 28 females, mean age 57 years, mean disease onset 24 years. At omalizumab discontinuation, 88% were oral corticosteroids-dependent with annual mean rate of 4.0 clinically significant exacerbations, 0.30 exacerbations needing emergency room visits or hospitalization; absenteeism due to disease was 10.4 days per patient. Switch to mepolizumab improved all clinical outcomes, reducing total exacerbation rate (RR = 0.06, 95% CI 0.03 to 0.14), oral corticosteroids -dependent patients (OR = 0.02, 95% CI 0.005 to 0.08), and the number of lost working days because of uncontrolled disease (Δ = -7.9, 95% CI -11.2 to -4.6). Pulmonary function improved, as well as serum IgE, fractional exhaled nitric oxide and eosinophils decreased. Mean annual costs were € 12,239 for omalizumab and € 12,639 for mepolizumab (Δ = € 400, 95% CI -1,588 to 2,389); the increment due to drug therapy (+ € 1,581) was almost offset by savings regarding all other cost items (- € 1,181). Conclusions: Patients with severe eosinophilic asthma, not controlled by omalizumab, experienced comprehensive benefits in asthma control by switching to mepolizumab. These relevant improvements were burdened by only very slight increases in economic costs.

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

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.

Evaluation of the peripheral blood eosinophil count as a predictor for fractional exhaled nitric oxide or bronchodilator reversibility test outcome

2021 ◽  
Vol 42 (3) ◽  
pp. 228-234
Author(s):  
Bo Zhao ◽  
Haiming Zheng ◽  
Xiaopan Li ◽  
Rui Zheng
Keyword(s):  
Nitric Oxide ◽  
Roc Curve ◽  
Peripheral Blood ◽  
Eosinophil Count ◽  
Blood Eosinophil ◽  
Test Results ◽  
Fractional Exhaled Nitric Oxide ◽  
Peripheral Blood Eosinophil ◽  
Blood Eosinophil Count ◽  
Feno Level

Objective: This study aimed to explore the usefulness of the peripheral blood eosinophil count (PBEC) in assessing the level of fractional exhaled nitric oxide (FeNO) and predicting bronchodilation test results. Methods: We retrospectively analyzed the data of 384 outpatients who underwent FeNO measurement at our Department of Respiratory and Critical Care Medicine from March to June 2019. The FeNO level was compared among different PBECs to explore the association among them. Furthermore, the sensitivity and specificity of PBECs in predicting bronchodilation test results were assessed by using receiver operating characteristic (ROC) curve analysis. Results: There was a moderate correlation between PBECs and FeNO levels (r = 0.414; p < 0.05). In the subjects with PBECs ≥ 0.3 × 109/L, the median FeNO level was 39 ppb (interquartile range, 22.5‐65.5 ppb), significantly higher than in the subjects with PBECs < 0.3 × 109/L. The area under the ROC curve was 0.707 (p < 0.05). The maximum Youden index (0.348) was at PBECs = 0.205 × 109/L, which achieved sensitivity and specificity of 63% and 71.8%, respectively. Conclusion: PBECs ≥ 0.3 × 109/L can predict a positive bronchodilation test result and a high FeNO level, with a probability of 50% in the subjects with chronic cough and shortness of breath; in the absence of corresponding symptoms and a low PBEC, the predictive value was small. For hospitals not able to conduct FeNO measurements, for outpatients with poor economic conditions, and for patients with confirmed or suspected novel coronavirus disease 2019, the PBEC, in conjunction with a patient's clinical symptoms, can improve the diagnostic accuracy of allergic asthma and assessment of airway inflammation while reducing the risk of infection.

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

CHEST Journal ◽  
2001 ◽  
Vol 119 (5) ◽  
pp. 1322-1328 ◽  
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

Fraction of Exhaled Nitric Oxide Levels Are Elevated in People Living With Human Immunodeficiency Virus Compared to Uninfected Controls, Suggesting Increased Eosinophilic Airway Inflammation

2020 ◽  
Author(s):  
Rebekka F Thudium ◽  
Nicolai L P Hughes ◽  
Shoaib Afzal ◽  
Yunus Çolak ◽  
Marco Gelpi ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Human Immunodeficiency Virus ◽  
Airway Inflammation ◽  
Immunoglobulin E ◽  
Exhaled Nitric Oxide ◽  
Airflow Limitation ◽  
Hiv Status ◽  
General Population Study ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background Increased risk of asthma and chronic obstructive pulmonary disease has been reported in people living with human immunodeficiency virus (PLWH). Fraction of exhaled nitric oxide (FeNO) is a marker of eosinophilic airway inflammation. We assessed FeNO levels in PLWH and matched uninfected controls and investigated whether human immunodeficiency virus (HIV) status is independently associated with elevated FeNO. Methods FeNO was quantified by NIOX Vero and pulmonary function was assessed by spirometry in 432 PLWH from the Copenhagen Comorbidity in HIV Infection Study and in 1618 age- and sex-matched uninfected controls from the Copenhagen General Population Study. Elevated FeNO was defined as ≥25 parts per billion. Associations between FeNO and HIV status were adjusted for known potential confounders. Results Mean age of PLWH was 50.7 (standard deviation [SD], 11.1) years and 97.4% received combination antiretroviral therapy. PLWH had higher FeNO than uninfected controls (median, 17.0 [interquartile range {IQR}, 11.0–26.0] vs 13.0 [IQR, 9.0–19.0]; P &lt; .001). Also, PLWH had a higher prevalence of elevated FeNO than uninfected controls (27.5% vs 12.3%; P &lt; .001). This association remained after adjusting for age, sex, height, smoking status, use of airway medication, blood eosinophils, and immunoglobulin E (adjusted OR [aOR], 3.56 [95% CI, 2.51–5.04]; P &lt; .001). Elevated FeNO was associated with self-reported asthma (aOR, 2.65 [95% CI, 1.66–4.24]; P &lt; .001) but not with airflow limitation (aOR, 1.07 [95% CI, .71–1.62]; P = .745). Conclusions HIV status was independently associated with elevated FeNO, suggesting increased eosinophilic airway inflammation. The potential impact on chronic lung disease pathogenesis needs further investigation.

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