Diagnostic accuracy of fractional exhaled nitric oxide in predicting cough variant asthma and eosinophilic bronchitis in adult patients with chronic cough: A systematic review and meta-analysis

Publication date: Available online 11 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Woo-Jung Song, Hyun Jung Kim, Ji-Su Shim, Ha-Kyeong Won, Sung-Yoon Kang, Kyoung-Hee Sohn, Byung-Keun Kim, Eun-Jung Jo, Min-Hye Kim, Sang-Heon Kim, Heung-Woo Park, Sun-Sin Kim, Yoon-Seok Chang, Alyn H. Morice, Byung-Jae Lee, Sang-Heon Cho
BackgroundIndividual studies suggested the utility of fractional exhaled nitric oxide (FeNO) in detecting cough variant asthma (CVA) and eosinophilic bronchitis (EB) in chronic cough patients.ObjectiveTo obtain summary estimates of diagnostic test accuracy of FeNO in predicting CVA and/or EB in adult patients with chronic coughMethodsElectronic databases were searched for studies published until January 2016, without language restriction. Cross-sectional studies which reported the diagnostic accuracy of FeNO for detecting CVA or EB were included. Risk of bias was assessed with QUADAS-2. Random effects meta-analyses were performed to obtain summary estimates of the diagnostic accuracy of FeNO.ResultsA total of 15 studies involving 2,187 adult patients with chronic cough were identified. FeNO had a moderate diagnostic accuracy in predicting CVA in patients with chronic cough, showing the summary area under curve (AUC) 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 non-asthmatic chronic cough population, the diagnostic accuracy to predict EB was found to be relatively lower (the summary AUC 0.81 [95% CI: 0.77-0.84]) and specificity was inconsistent.ConclusionsThe present meta-analyses indicated the diagnostic potential of FeNO as a 'rule in' test for detecting CVA in adult patients with chronic cough. However, FeNO may not be useful to predict EB in non-asthmatic chronic cough. These findings warrant further studies to validate the roles of FeNO in clinical practice of chronic cough patients.

Teaser

Fractional exhaled nitric oxide has a diagnostic potential as a 'rule in' test for cough variant asthma in patients with chronic cough.


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