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Validation of ATS clinical practice guideline cut-points for FeNO in asthma.

Abstract：

BACKGROUND:The American Thoracic society (ATS) has suggested using fractional exhaled nitric oxide (FeNO) to monitor the level of eosinophilic (EOS) airway inflammation in asthma, but validation of the proposed cut-points is required in real-life populations. OBJECTIVE:To validate FeNO cut-points suggested by ATS in relation to sputum EOS count in a real life population of asthma patients. METHODS:All patients referred consecutively over a 12-months period for specialist assessment of asthma, were examined with FeNO and induced sputum, and re-examined 12 months later. The predicted values of a positive and a negative test (PPV and NPV) for a cut off ≥3% EOS in sputum were calculated. Change in FeNO was defined in accordance with ATS (>20% or 10 ppb if FeNO was <50 ppb). RESULTS:144 adult asthma patients were examined (59% female). Low FeNO (<25 ppb) at baseline was found in 94 (65%), FeNO between 25 and 50 ppb in 34 (24%) subjects and high FeNO >50 ppb in 16 (11%) subjects. The PPV for FeNO >25 ppb and >50 ppb to predict EOS ≥3% was 45% and 77%, NPV was 88% and 83%. The sensitivity decreased from 70% to 37% at the >50 ppb cut-off. A significant reduction in FeNO was associated with a reduction in sputum EOS (p = 0.01). CONCLUSION:The findings support the validity of the FeNO cut-points suggested by ATS to monitor eosinophilic airway inflammation in asthma. However, in this real-life population, a large proportion of patients had intermediate FeNO values, which may limit the clinical usefulness of the ATS FeNO cut-points.

journal_name

Respir Med

journal_title

Respiratory medicine

authors

Jeppegaard M,Veidal S,Sverrild A,Backer V,Porsbjerg C

doi

10.1016/j.rmed.2018.09.014

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

22-29

eissn

0954-6111

issn

1532-3064

pii

S0954-6111(18)30296-8

journal_volume

144

pub_type

杂志文章

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