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

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@article{435d9e67205c4a459b06cc95d9ee3da9,
title = "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.",
author = "Sandra Veidal and Asger Sverrild and Vibeke Backer and Celeste Porsbjerg",
note = "Copyright {\circledC} 2018. Published by Elsevier Ltd.",
year = "2018",
month = "11",
doi = "10.1016/j.rmed.2018.09.014",
language = "English",
volume = "144",
pages = "22--29",
journal = "Respiratory medicine",
issn = "0954-6111",
publisher = "W.B./Saunders Co. Ltd",

}

RIS

TY - JOUR

T1 - Validation of ATS clinical practice guideline cut-points for FeNO in asthma

AU - Veidal, Sandra

AU - Sverrild, Asger

AU - Backer, Vibeke

AU - Porsbjerg, Celeste

N1 - Copyright © 2018. Published by Elsevier Ltd.

PY - 2018/11

Y1 - 2018/11

N2 - 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.

AB - 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.

U2 - 10.1016/j.rmed.2018.09.014

DO - 10.1016/j.rmed.2018.09.014

M3 - Journal article

VL - 144

SP - 22

EP - 29

JO - Respiratory medicine

JF - Respiratory medicine

SN - 0954-6111

ER -

ID: 55605279