Prospective Evaluation of the Validity of Exhaled Nitric Oxide for the Diagnosis of Asthma

doi:10.1378/chest.123.3.751

Chest

Volume 123, Issue 3, March 2003, Pages 751-756

https://doi.org/10.1378/chest.123.3.751 Get rights and content

Study objective

Exhaled nitric oxide (NO) levels are significantly elevated in patients with inflammatory airways disorders such as asthma, and the measurement of exhaled NO has been proposed as a noninvasive marker of airways inflammation. The aim of this study was to assess the accuracy of exhaled NO levels for the diagnosis of asthma.

Methods

Two hundred forty consecutive, nonsmoking, steroid-naive patients, who were referred to our outpatient clinic with symptoms suggestive of obstructive airways disease, were investigated. Asthma was diagnosed in 160 patients on the basis of the presence of significant airways reversibility (ΔFEV₁ > 12% predicted) and/or airways hyperresponsiveness (provocative concentration of histamine causing a 20% fall in FEV₁ ≤ 8 mg/mL). Prior to lung function measurements, exhaled NO was measured during a single-breath exhalation, according to European Respiratory Society and American Thoracic Society guidelines.

Results

The measurement of exhaled NO in our study population showed, at a cutoff level of 16 parts per billion, a specificity for the diagnosis of asthma of 90% and a positive predictive value of > 90%.

Conclusions

These findings suggest that the simple and absolutely noninvasive measurement of exhaled NO can be used as an additional diagnostic tool for the screening of patients with a suspected diagnosis of asthma.

Section snippets

Patients

Patients were recruited among adult patients with symptoms suggestive of obstructive airway disease (eg, cough, wheezing, episodic dyspnea), who were consecutively referred to the asthma outpatient clinic of the university hospital Gasthuisberg, Leuven, Belgium, for diagnostic evaluation. In these patients, the diagnosis of asthma was further investigated by means of a thorough clinical assessment, pulmonary function tests, histamine challenge tests, and other diagnostic tests, when indicated,

Patient Characteristics

The patient characteristics of both study groups are shown in Table 1. Group A consisted of 160 patients with a diagnosis of asthma. Group B consisted of 80 patients in whom a diagnosis of asthma could not be established due to the absence of variable airway obstruction and/or airway hyperresponsiveness. There was no significant difference in age, female/male ratio, FEV₁, FVC, or FEV₁/FVC between both groups. A review of the medical records of the patients in group B (n = 80) demonstrated that

Discussion

In the present study, we have demonstrated that the concentration of NO in the exhaled air of patients with asthma was significantly increased when compared to patients with similar symptoms in the absence of asthma. The exhaled NO level in these nonasthmatic patients was similar to the levels in normal subjects at our setting (10 ppb).⁹ The conditions that were responsible for the complaints of the nonasthmatic patients included postnasal drip and chronic rhinitis, chronic sinusitis,

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: Support was provided by a grant from the medical foundation Mathilde Horlait-Dapsens.

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Chest

Clinical InvestigationsAsthmaProspective Evaluation of the Validity of Exhaled Nitric Oxide for the Diagnosis of Asthmaa

Study objective

Methods

Results

Conclusions

Section snippets

Patients

Patient Characteristics

Discussion

Thorax

Chest

Lancet

Chest

Mucosal inflammation in asthma

Am Rev Respir Dis

Pathophysiology of asthma

Br J Clin Pharmacol

Relationship between the inflammatory infiltrate in bronchial biopsy specimens and clinical severity of asthma in patients treated with inhaled steroids

Thorax

Noninvasive methods to measure airway inflammation: future considerations

Eur Respir J

Exhaled nitric oxide correlates with airway hyperresponsiveness in steroid-naive patients with mild asthma

Am J Respir Crit Care Med

Clinical Investigations
Asthma
Prospective Evaluation of the Validity of Exhaled Nitric Oxide for the Diagnosis of Asthma^a