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First published online on October 20, 2007
Chest, doi:10.1378/chest.07-1561
A more recent version of this article appeared on April 1, 2008
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PORTABLE EXHALED NITRIC OXIDE AS A SCREENING TOOL FOR ASTHMA IN YOUNG ADULTS DURING POLLEN SEASON

Konstantinos Kostikas, MD; Andriana I. Papaioannou, MD; Kalliopi Tanou, MD; Angela Koutsokera, MD; Maria Papala, MD and Konstantinos I. Gourgoulianis, MD

Respiratory Medicine Department, University of Thessaly Medical School

ktk{at}otenet.gr

Abstract

BackgroundThe fraction of exhaled NO (FeNO) is valuable for the follow-up of asthmatic patients. However, its usefulness as a screening tool for asthma is not established.

MethodsWe screened a population of 961 university students with a modified European Community Respiratory Health Survey questionnaire that has been previously used for the screening of respiratory symptoms related to asthma. All subjects with a positive answer to at least one question (n=149) were submitted to FeNO measurement with a portable NO analyzer. Subsequently, they were submitted to spirometry and evaluated by a physician blinded to FeNO measurements. Seventy students with no respiratory symptoms served as controls.

ResultsAsthma was diagnosed in 63 subjects and allergic rhinitis in 57 subjects. Asthmatics presented higher FeNO than controls [median (interquartile ranges)] [20 (14, 31) ppb vs. 11 (7, 13) ppb respectively, p<0.0001], whereas they did not differ from patients with allergic rhinitis [17 (12, 23) ppb, p=0.28]. FeNO values >19 ppb presented specificity 85.2% and sensitivity 52.4% for the diagnosis of asthma (AUC=0.723). The diagnostic performance of FeNO was better in non-smokers (AUC=0.805); yet FeNO values >25 ppb were characterized by specificity >90% for the diagnosis of asthma both in smokers and in non-smokers. However, FeNO was not a good marker for the differentiation between asthma and allergic rhinitis.

ConclusionsFeNO measurement with a portable analyzer is useful for the screening for asthma in young adults. Significant confounding factors are allergic rhinitis and current smoking.

Key Words: exhaled nitric oxide • screening • asthma • allergic rhinitis • smoking


Related Editorial

Exhaled Nitric Oxide in Asthma: From Diagnosis, to Monitoring, to Screening: Are We There Yet?
Natalia M. Grob and Raed A. Dweik
Chest 2008 133: 837-839. [Full Text] [PDF]



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N. M. Grob and R. A. Dweik
Exhaled Nitric Oxide in Asthma: From Diagnosis, to Monitoring, to Screening: Are We There Yet?
Chest, April 1, 2008; 133(4): 837 - 839.
[Full Text] [PDF]


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