The Diagnostic Accuracy of Fractional Exhaled Nitric Oxide Testing in Asthma: A Systematic Review and Meta-analyses

Zhen Wang, Paolo T. Pianosi, Karina A. Keogh, Feras Zaiem, Mouaz Alsawas, Fares Alahdab, Jehad Almasri, Khaled Mohammed, Laura Larrea-Mantilla, Wigdan Farah, Lubna Daraz, Patricia Barrionuevo, Allison S. Morrow, Larry J. Prokop, Mohammad H Murad

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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 languageEnglish (US)
JournalMayo Clinic Proceedings
DOIs
StateAccepted/In press - Jan 1 2017

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Meta-Analysis
Nitric Oxide
Asthma
Adrenal Cortex Hormones
Databases
MEDLINE
ROC Curve
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The Diagnostic Accuracy of Fractional Exhaled Nitric Oxide Testing in Asthma : A Systematic Review and Meta-analyses. / Wang, Zhen; Pianosi, Paolo T.; Keogh, Karina A.; Zaiem, Feras; Alsawas, Mouaz; Alahdab, Fares; Almasri, Jehad; Mohammed, Khaled; Larrea-Mantilla, Laura; Farah, Wigdan; Daraz, Lubna; Barrionuevo, Patricia; Morrow, Allison S.; Prokop, Larry J.; Murad, Mohammad H.

In: Mayo Clinic Proceedings, 01.01.2017.

Research output: Contribution to journalArticle

Wang, Z, Pianosi, PT, Keogh, KA, Zaiem, F, Alsawas, M, Alahdab, F, Almasri, J, Mohammed, K, Larrea-Mantilla, L, Farah, W, Daraz, L, Barrionuevo, P, Morrow, AS, Prokop, LJ & Murad, MH 2017, 'The Diagnostic Accuracy of Fractional Exhaled Nitric Oxide Testing in Asthma: A Systematic Review and Meta-analyses', Mayo Clinic Proceedings. https://doi.org/10.1016/j.mayocp.2017.11.012
Wang, Zhen ; Pianosi, Paolo T. ; Keogh, Karina A. ; Zaiem, Feras ; Alsawas, Mouaz ; Alahdab, Fares ; Almasri, Jehad ; Mohammed, Khaled ; Larrea-Mantilla, Laura ; Farah, Wigdan ; Daraz, Lubna ; Barrionuevo, Patricia ; Morrow, Allison S. ; Prokop, Larry J. ; Murad, Mohammad H. / The Diagnostic Accuracy of Fractional Exhaled Nitric Oxide Testing in Asthma : A Systematic Review and Meta-analyses. In: Mayo Clinic Proceedings. 2017.
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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.",
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T1 - The Diagnostic Accuracy of Fractional Exhaled Nitric Oxide Testing in Asthma

T2 - A Systematic Review and Meta-analyses

AU - Wang, Zhen

AU - Pianosi, Paolo T.

AU - Keogh, Karina A.

AU - Zaiem, Feras

AU - Alsawas, Mouaz

AU - Alahdab, Fares

AU - Almasri, Jehad

AU - Mohammed, Khaled

AU - Larrea-Mantilla, Laura

AU - Farah, Wigdan

AU - Daraz, Lubna

AU - Barrionuevo, Patricia

AU - Morrow, Allison S.

AU - Prokop, Larry J.

AU - Murad, Mohammad H

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

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