Document Detail

Utility of nitric oxide for the diagnosis of asthma in an allergy clinic population.
MedLine Citation:
PMID:  21439165     Owner:  NLM     Status:  MEDLINE    
Fractionated exhaled nitric oxide (FeNO) expression is increased in airway inflammation and several studies have suggested that FeNO measurement can be useful in patients with asthma. Atopic individuals have increased FeNO levels, indicating that atopy may be a codeterminant in FeNO production. The aim of this study was to determine the discriminative value of FeNO for asthma and other atopic conditions in the general allergy clinic. Patients referred to the outpatient allergy clinic were screened. A standardized questionnaire was taken and atopic status was assessed (skin-prick test or specific plasma IgE). FeNO level and spirometry were measured. If the patient's history was suspect for asthma, a provocative concentration causing a 20% decrease in forced expiratory volume in 1 second (PC(20)) histamine challenge followed. One hundred fourteen steroid-naive patients were included. Forty-two subjects were diagnosed as asthmatic patients and 72 were diagnosed as nonasthmatic patients, comprising patients with allergic rhinitis (n = 32), nonallergic rhinitis (n = 11), urticaria (n = 11), eczema (n = 7), and other (n = 11). Asthmatic patients had a higher FeNO level than nonasthmatic patients (44 ppb versus 17 ppb; p < 0.001). Receiver operating characteristic curve analysis revealed the optimal FeNO level to distinguish asthma from nonasthma at 27 ppb, with a sensitivity of 78%, specificity of 92%, a positive predictive value of 86%, and a negative predictive value of 87%. Increased FeNO was positively correlated with the presence of respiratory symptoms (p < 0.01), airflow reversibility (p < 0.001), total IgE (p < 0.001), and negatively correlated with PC(20) histamine (p = 0.019). Multivariate analysis revealed that atopy was not a significant predictor of FeNO in asthmatic patients. Measuring FeNO is a simple and useful test to differentiate new asthma patients from those with other atopic conditions in a general allergy clinic.
Danielle Cordeiro; Arjan Rudolphus; Erik Snoey; Gert-Jan Braunstahl
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Allergy and asthma proceedings : the official journal of regional and state allergy societies     Volume:  32     ISSN:  1539-6304     ISO Abbreviation:  Allergy Asthma Proc     Publication Date:    2011 Mar-Apr
Date Detail:
Created Date:  2011-03-28     Completed Date:  2011-09-30     Revised Date:  2012-05-31    
Medline Journal Info:
Nlm Unique ID:  9603640     Medline TA:  Allergy Asthma Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  119-26     Citation Subset:  IM    
Department of Pulmonary Medicine, St. Franciscus Gasthuis, Rotterdam, The Netherlands.
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MeSH Terms
Aged, 80 and over
Asthma / diagnosis*,  physiopathology
Breath Tests
Forced Expiratory Volume / immunology
Hypersensitivity / diagnosis*,  physiopathology
Immunoglobulin E / blood,  diagnostic use
Middle Aged
Nitric Oxide* / analysis,  diagnostic use
ROC Curve
Sensitivity and Specificity
Skin Tests
Reg. No./Substance:
10102-43-9/Nitric Oxide; 37341-29-0/Immunoglobulin E

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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