ASTHMA

Exhaled nitric oxide in the diagnosis of asthma: comparison with bronchial provocation tests

N Berkman, A Avital, R Breuer, E Bardach, C Springer, S Godfrey

Institute of Pulmonology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

Correspondence to:
Correspondence to:
Dr N Berkman
Institute of Pulmonology, Hadassah University Hospital, POB 12000, Jerusalem, Israel il-91120; neville{at}hadassah.org.il

Background: Bronchial provocation tests such as exercise, methacholine (MCH), and adenosine-5'-monophosphate (AMP) challenges are used extensively in the diagnosis of asthma. A study was undertaken to determine whether exhaled nitric oxide (eNO) can be used to diagnose asthma in patients with non-specific respiratory symptoms and to compare this test with conventional provocation tests.

Methods: Patients with non-specific respiratory symptoms and normal spirometric parameters were included in the study. eNO was measured and exercise, MCH and AMP challenges performed in all subjects. Patients were defined as asthmatic based on clinical follow up 24 months after testing.

Results: Forty patients were considered asthmatic and 45 were not. The area under receiver operating characteristic curves gave values of 0.896 for eNO, 0.781 for exercise, 0.924 for MCH, and 0.939 for AMP (p = 0.033, 0.575 and 0.085 for eNO v exercise, MCH and AMP respectively). From our data, a cut off value of NO >7 ppb at a flow rate of 250 ml/s best differentiates between asthmatics and non-asthmatics (sensitivity 82.5%, specificity 88.9%). Optimal cut off values for other tests were exercise: FEV₁ 10% (sensitivity 57.9%, specificity 100%); PC₂₀-MCH: 3 mg/ml (sensitivity 87.5%, specificity 86.7%); and PC₂₀-AMP: 150 mg/ml (sensitivity 89.5%, specificity 95.6%).

Conclusions: Measurement of eNO can be used as a safe, simple and rapid test for the diagnosis of asthma and is as good as bronchial provocation tests.

Abbreviations: AMP, adenosine 5'-monophosphate; eNO, exhaled nitric oxide; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; MCH, methacholine; NO, nitric oxide

Keywords: asthma; exhaled nitric oxide; exercise; methacholine; adenosine 5'-monophosphate (AMP); diagnosis

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Reddel, H. K., Taylor, D. R., Bateman, E. D., Boulet, L.-P., Boushey, H. A., Busse, W. W., Casale, T. B., Chanez, P., Enright, P. L., Gibson, P. G., de Jongste, J. C., Kerstjens, H. A. M., Lazarus, S. C., Levy, M. L., O'Byrne, P. M., Partridge, M. R., Pavord, I. D., Sears, M. R., Sterk, P. J., Stoloff, S. W., Sullivan, S. D., Szefler, S. J., Thomas, M. D., Wenzel, S. E., on behalf of the American Thoracic Society/Europea, (2009). An Official American Thoracic Society/European Respiratory Society Statement: Asthma Control and Exacerbations: Standardizing Endpoints for Clinical Asthma Trials and Clinical Practice. Am. J. Respir. Crit. Care Med. 180: 59-99 [Abstract] [Full Text]  
• Kostikas, K., Papaioannou, A. I., Tanou, K., Koutsokera, A., Papala, M., Gourgoulianis, K. I. (2008). Portable Exhaled Nitric Oxide as a Screening Tool for Asthma in Young Adults During Pollen Season. Chest 133: 906-913 [Abstract] [Full Text]  
• Travers, J., Marsh, S., Aldington, S., Williams, M., Shirtcliffe, P., Pritchard, A., Weatherall, M., Beasley, R. (2007). Reference Ranges for Exhaled Nitric Oxide Derived from a Random Community Survey of Adults. Am. J. Respir. Crit. Care Med. 176: 238-242 [Abstract] [Full Text]  
• Menzies, D., Nair, A., Lipworth, B. J. (2007). Portable Exhaled Nitric Oxide Measurement: Comparison With the "Gold Standard" Technique. Chest 131: 410-414 [Abstract] [Full Text]  
• Condorelli, P., Shin, H.-W., Aledia, A. S., Silkoff, P. E., George, S. C. (2007). A simple technique to characterize proximal and peripheral nitric oxide exchange using constant flow exhalations and an axial diffusion model. J. Appl. Physiol. 102: 417-425 [Abstract] [Full Text]  
• Taylor, D R, Pijnenburg, M W, Smith, A D, Jongste, J C D (2006). Exhaled nitric oxide measurements: clinical application and interpretation. Thorax 61: 817-827 [Abstract] [Full Text]  
• Gelb, A. F., Flynn Taylor, C., Shinar, C. M., Gutierrez, C., Zamel, N. (2006). Role of Spirometry and Exhaled Nitric Oxide To Predict Exacerbations in Treated Asthmatics. Chest 129: 1492-1499 [Abstract] [Full Text]  

eLetters:

Read all eLetters

The role of exhaled nitric oxide in asthma

Daniel K C Lee

Thorax Online, 13 May 2005 [Full text]