TY - JOUR
T1 - The Diagnostic Accuracy of Fractional Exhaled Nitric Oxide Testing in Asthma
T2 - A Systematic Review and Meta-analyses
AU - Wang, Zhen
AU - Pianosi, Paolo T.
AU - Keogh, Karina A.
AU - Zaiem, Feras
AU - Alsawas, Mouaz
AU - Alahdab, Fares
AU - Almasri, Jehad
AU - Mohammed, Khaled
AU - Larrea-Mantilla, Laura
AU - Farah, Wigdan
AU - Daraz, Lubna
AU - Barrionuevo, Patricia
AU - Morrow, Allison S.
AU - Prokop, Larry J.
AU - Murad, Mohammad Hassan
N1 - Publisher Copyright:
© 2017 Mayo Foundation for Medical Education and Research
PY - 2018/2
Y1 - 2018/2
N2 - Objective: To evaluate the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) measurement in individuals with suspected asthma. Methods: We searched MEDLINE, EMBASE, PsycINFO, Cochrane databases, and SciVerse Scopus from the databases’ inception through April 4, 2017, for studies that enrolled patients aged 5 years and older with suspected asthma and evaluated FeNO diagnostic accuracy. Independent reviewers selected studies and extracted data. We used the symmetric hierarchical summary receiver operating characteristic models to estimate test performance. Results: We included 43 studies with a total of 13,747 patients. In adults, using FeNO cutoffs of less than 20, 20 to 29, 30 to 39, and 40 or more parts per billion, FeNO testing had sensitivities of 0.80, 0.69, 0.53, and 0.41, respectively, and specificities of 0.64, 0.78, 0.85, and 0.93, respectively. In children, using FeNO cutoffs of less than 20 and 20 to 29 parts per billion, FeNO testing had sensitivities of 0.78 and 0.61, respectively, and specificities of 0.79 and 0.89, respectively. Depending on the FeNO cutoff, the posttest odds of having asthma with a positive FeNO test result increased by 2.80- to 7.00-fold. Diagnostic accuracy was modestly better in corticosteroid-naive asthmatics, children, and nonsmokers than in the overall population. Conclusion: Fractional exhaled nitric oxide measurement has moderate accuracy to diagnose asthma in individuals aged 5 years and older. Test performance may be modestly better in corticosteroid-naive asthmatics, children, and nonsmokers than in the general population with suspected asthma.
AB - Objective: To evaluate the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) measurement in individuals with suspected asthma. Methods: We searched MEDLINE, EMBASE, PsycINFO, Cochrane databases, and SciVerse Scopus from the databases’ inception through April 4, 2017, for studies that enrolled patients aged 5 years and older with suspected asthma and evaluated FeNO diagnostic accuracy. Independent reviewers selected studies and extracted data. We used the symmetric hierarchical summary receiver operating characteristic models to estimate test performance. Results: We included 43 studies with a total of 13,747 patients. In adults, using FeNO cutoffs of less than 20, 20 to 29, 30 to 39, and 40 or more parts per billion, FeNO testing had sensitivities of 0.80, 0.69, 0.53, and 0.41, respectively, and specificities of 0.64, 0.78, 0.85, and 0.93, respectively. In children, using FeNO cutoffs of less than 20 and 20 to 29 parts per billion, FeNO testing had sensitivities of 0.78 and 0.61, respectively, and specificities of 0.79 and 0.89, respectively. Depending on the FeNO cutoff, the posttest odds of having asthma with a positive FeNO test result increased by 2.80- to 7.00-fold. Diagnostic accuracy was modestly better in corticosteroid-naive asthmatics, children, and nonsmokers than in the overall population. Conclusion: Fractional exhaled nitric oxide measurement has moderate accuracy to diagnose asthma in individuals aged 5 years and older. Test performance may be modestly better in corticosteroid-naive asthmatics, children, and nonsmokers than in the general population with suspected asthma.
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U2 - 10.1016/j.mayocp.2017.11.012
DO - 10.1016/j.mayocp.2017.11.012
M3 - Article
C2 - 29275031
AN - SCOPUS:85038937287
SN - 0025-6196
VL - 93
SP - 191
EP - 198
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 2
ER -