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

• Published in: Journal of allergy and clinical immunology Vol. 140; no. 3; pp. 701 - 709
• Main Authors: Song, Woo-Jung, MD, Kim, Hyun Jung, MPH, PhD, Shim, Ji-Su, MD, Won, Ha-Kyeong, MD, Kang, Sung-Yoon, MD, Sohn, Kyoung-Hee, MD, Kim, Byung-Keun, MD, Jo, Eun-Jung, MD, Kim, Min-Hye, MD, PhD, Kim, Sang-Heon, MD, PhD, Park, Heung-Woo, MD, PhD, Kim, Sun-Sin, MD, PhD, Chang, Yoon-Seok, MD, PhD, Morice, Alyn H., MD, FRCP, Lee, Byung-Jae, MD, PhD, Cho, Sang-Heon, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Adult; Allergy and Immunology; asthma; Asthma - diagnosis; Asthma - metabolism; Bronchitis - diagnosis; Bronchitis - metabolism; Chronic cough; Chronic Disease; Cough - diagnosis; Cough - metabolism; Eosinophilia - diagnosis; Eosinophilia - metabolism; eosinophilic bronchitis; Exhalation; fractional exhaled nitric oxide; Humans; Nitric Oxide - metabolism; systematic review; Cough-variant asthma; NO; Chronic cough; F eno; HSROC; ROC; asthma; AHR; systematic review; Airway hyperresponsiveness; AUC; CVA; fractional exhaled nitric oxide; Receiver operating characteristic; Research question; eosinophilic bronchitis; Area under the curve; Nitric oxide; Hierarchical summary receiver operating characteristic; EB; RQ; Feno
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2016.11.037

Background Individual studies have suggested the utility of fractional exhaled nitric oxide (F eno ) 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 F eno 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 F eno 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 F eno measurement. Results A total of 15 studies involving 2187 adults with chronic cough were identified. F eno 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 F eno measurement as a rule-in test for detecting CVA in adult patients with chronic cough. However, F eno measurement may not be useful to predict EB in nonasthmatic subjects with chronic cough. These findings warrant further studies to validate the roles of F eno measurement in clinical practice of patients with chronic cough.