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Spirometry-adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children.
Martins C1,
Silva D1,2,
Severo M2,3,
Rufo J2,4,
Paciência I2,4,
Madureira J4,
Padrão P5,
Moreira P5,
Delgado L1,2,
Oliveira Fernandes E4,
Barros H2,3,
Malmberg P6,
Moreira A1,2,3,5.
- 1
- Department of Immunoallergology, Centro Hospitalar de São João, Porto, Portugal.
- 2
- Faculty of Medicine, Basic and Clinical Immunology, University of Porto, Porto, Portugal.
- 3
- Institute of Public Health, University of Porto, Porto, Portugal.
- 4
- Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal.
- 5
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.
- 6
- Department of Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Abstract
Spirometry and exhaled nitric oxide are two important complimentary tools to identify and assess asthma control in children. We aimed to determine the ability of a new suggested spirometry-adjusted fraction of exhaled nitric oxide (NO) index in doing that. A random sample of 1602 schoolchildren were screened by a health questionnaire, skin prick tests, spirometry with bronchodilation and exhaled NO. A total of 662 children were included with median (IQR) exhaled NO 11(14) ppb. Receiver operating characteristic (ROC) curves using exhaled NO equations from Malmberg, Kovesi and Buchvald, and spirometry-adjusted fraction of exhaled NO values were applied to identify asthmatic children and uncontrolled asthma. Receiver operating characteristic (ROC) curves failed to identify asthmatic children (all AUC < 0.700). Spirometry-adjusted fraction of exhaled NO/FEV1 (AUC = 0.712; P = .010) and NO/FEF25%-75% (AUC = 0.735 P = .004) had a fair and increased ability to identify uncontrolled disease compared with exhaled NO (AUC = 0.707; P = .011) or the Malmberg equation (AUC = 0.701; P = .014). Sensitivity and specificity identifying non-controlled asthma were 59% and 81%, respectively, for the cut-off value of 9.7 ppb/L for exhaled NO/FEV1 , and 40% and 100% for 15.7 ppb/L/s for exhaled NO/FEF25%-75% . Exhaled NO did not allow to identify childhood asthma. Spirometry-adjusted fraction of exhaled NO performed better-assessing asthma control in children. Thus, although more validation studies are needed, we suggest its use in epidemiological studies to assess asthma control.
© 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.
KEYWORDS:
asthma; asthma control; children; exhaled nitric oxide; spirometry
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