Diagnostic accuracy of fractional exhaled nitric oxide measurement in predicting cough-variant asthma and eosinophilic bronchitis in adults with chronic cough: A systematic review and meta-analysis

Woo Jung Song, Hyun Jung Kim, Ji Su Shim, Ha Kyeong Won, Sung Yoon Kang, Kyoung Hee Sohn, Byung Keun Kim, Eun Jung Jo, Min Hye Kim, Sang Heon Kim, Heung Woo Park, Sun Sin Kim, Yoon Seok Chang, Alyn H. Morice, Byung Jae Lee, Sang Heon Cho

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55 Scopus citations

Abstract

Background Individual studies have suggested the utility of fractional exhaled nitric oxide (FENO) measurement in detecting cough-variant asthma (CVA) and eosinophilic bronchitis (EB) in patients with chronic cough. Objective We sought to obtain summary estimates of diagnostic test accuracy of FENO measurement in predicting CVA, EB, or both in adults with chronic cough. Methods Electronic databases were searched for studies published until January 2016, without language restriction. Cross-sectional studies that reported the diagnostic accuracy of FENO measurement for detecting CVA or EB were included. Risk of bias was assessed with Quality Assessment of Diagnostic Accuracy Studies 2. Random effects meta-analyses were performed to obtain summary estimates of the diagnostic accuracy of FENO measurement. Results A total of 15 studies involving 2187 adults with chronic cough were identified. FENO measurement had a moderate diagnostic accuracy in predicting CVA in patients with chronic cough, showing the summary area under the curve to be 0.87 (95% CI, 0.83-0.89). Specificity was higher and more consistent than sensitivity (0.85 [95% CI, 0.81-0.88] and 0.72 [95% CI, 0.61-0.81], respectively). However, in the nonasthmatic population with chronic cough, the diagnostic accuracy to predict EB was found to be relatively lower (summary area under the curve, 0.81 [95% CI, 0.77-0.84]), and specificity was inconsistent. Conclusions The present meta-analyses indicated the diagnostic potential of FENO measurement as a rule-in test for detecting CVA in adult patients with chronic cough. However, FENO measurement may not be useful to predict EB in nonasthmatic subjects with chronic cough. These findings warrant further studies to validate the roles of FENO measurement in clinical practice of patients with chronic cough.

Original languageEnglish
Pages (from-to)701-709
Number of pages9
JournalJournal of Allergy and Clinical Immunology
Volume140
Issue number3
DOIs
StatePublished - Sep 2017

Keywords

  • Chronic cough
  • asthma
  • eosinophilic bronchitis
  • fractional exhaled nitric oxide
  • systematic review

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