Abstract
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. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42016047887
| Original language | English (US) |
|---|---|
| Pages (from-to) | 191-198 |
| Number of pages | 8 |
| Journal | Mayo Clinic Proceedings |
| Volume | 93 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2018 |
| Externally published | Yes |
Bibliographical note
Funding Information:Grant Support: This work was funded by the Agency for Healthcare Research and Quality under contract HHSA 290201500013I to support evidence synthesis as part of the Evidence-based Practice Center Program.
Funding Information:
We gratefully acknowledge the following individuals for their contributions to this study: the task order officers from Agency for Healthcare Research and Quality; Anas Daghestani, MD, Austin Regional Clinic; Serpil C. Erzurum, MD, Cleveland Clinic Foundation; Elliot Israel, MD, Brigham and Women's Hospital; Rohit Katial, MD, University of Colorado; Nicholas Kenyon, MD, University of California, Davis; Todd A. Mahr, MD, Gundersen Lutheran Medical Center; John G. Mastronarde, MD, MSc, Providence Portland Medical Center; Wayne J. Morgan, MD, University of Arizona College of Medicine; Shahzeb Munir, MD, University of Wisconsin School of Medicine and Public Health; Augusto Litonjua, MD, MPH, Harvard Medical School; John Sundy, MD, PhD, Duke University School of Medicine; and Sally Wenzel, MD, University of Pittsburgh Medical Center. The funding source had no role in conduct of the review; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the submitted manuscript; and decision to submit the manuscript for publication. The findings and conclusions in this article are those of the authors, who are responsible for its contents, and do not necessarily represent the views of the Agency for Healthcare Research and Quality or the US government. Therefore, no statement in this article should be construed as the official position of the Agency for Healthcare Research and Quality. Author contributions: All authors contributed to the acquisition, analysis, or interpretation of data for the study and critical revision of the submitted manuscript for important intellectual content. Concept and design: Drs Wang, Pianosi, Keogh, and Murad; drafting of the manuscript: Drs Wang, Pianosi, Keogh, and Murad; statistical analysis: Drs Wang and Murad; administrative, technical, or material support: Dr Alsawas. As the guarantors of the study, Drs Wang and Murad take full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.
Publisher Copyright:
© 2017 Mayo Foundation for Medical Education and Research
