ObjectiveTo explore the clinical features of atypical bronchial asthma with chief complaint of palpitations. MethodsTwelve cases with unexplained palpitations diagnosed by asthma were analyzed retrospectively. ResultsThe patients were diagnosed with asthma through bronchodilation test,skin prick tests,fractional exhaled nitric oxide (FeNO) and diagnostic treatment.The ratio of male to female cases was 1:5. The ventilation lung function of all patients was in normal range. The median time of misdiagnosis was 13.5(3-120) months. 41.6% of cases had dust mite positive skin prick test. The median value of FeNO was 32.75(18-54) ppb. The symptoms of all patients were relieved completely after standard treatment. ConclusionPalpatation may be a specific presentation of asthma characterized with eosinophilic airway inflammation which may be misdiagnosed as other diseases for a long time,especially in elder women. To improve the knowledge of this kind of atypical asthma,detailed medical history, experimental examinations and diagnostic treatment response are important to confirm the diagnosis in time.
ObjectiveTo explore the predictive value of fractional exhaled nitric oxide (FeNO) in the treatment response of adult asthmatic patients. Methods64 adult outpatients with asthma from Peking Union Hospital between March and September 2013 were recruited in the study. All patients completed asthma control test (ACT) together with exhaled nitric oxide (FeNO) and pulmonary function test. Then the patients were classified into a higher FeNO group (n=33) and a normal FeNO group (n=31) according to FeNO level. All patients accepted regular inhaled ICS/LABA treatment (salmeterol and fluticasone 50/250). Three months later all patients reaccepted ACT,FeNO and pulmonary function test. ResultsThe ACT score increased in all patients,and was significantly higher in the higher FeNO group than that in the normal FeNO group[22.07±5.49 vs. 19.23±5.48,t=2.893,P<0.05]. The complete control rate of the higher FeNO group was higher than that in the normal FeNO group (42.42% vs. 19.35%,χ2=3.960,P<0.05). The FEV1 and FEV1%pred of two groups both increased significantly (P<0.05),but there was no significant difference between two groups (P>0.05). Correlation analysis showed that FeNO and the declined rate of FeNO was negatively correlated with the ACT score(r=-0.302,P<0.05;r=0.674,P<0.01) and positively correlated with the improvement of ACT score (r=0.514,P<0.01;r=0.674,P<0.01). No significant correlation was found between FeNO and FEV1 or FEV1%pred. ConclusionThe effect of ICS/LABA therapy is better for asthma patients with higher FeNO. FeNO can be used for predicting the response to ICS/LABA therapy in patients with asthma and guiding the treatment.
Objective To determine the diagnostic value of fractional exhaled nitric ( FeNO)measurement in diagnosis of bronchial asthma. Methods The patients with unkown-cause respiratory symptoms including wheezing, cough, and breathlessness were enrolled from August to September in 2008.FeNO was measured by nitric oxide analyzer ( NIOX; Aerocrine AB; Solna, Sweden) . Bronchial challenge test ( BCT) or bronchodilator test was defined as golden standard for asthma diagnosis. The value of FeNO was assessed and the optimal operating point of FeNO testing was determined by the means of the receiver operating characteristic ( ROC) curves. Results A total of 101 patients were enrolled, in which 48 cases were diagnosed as asthma by positive yield in BCT ( in 38 cases) or bronchodilator test ( in 10 cases) . The severity of airway hyperresponsiveness ( AHR) judged by BCT was mild in 15 cases, moderate in 15 cases and severe in 8 cases. The levels of FeNO of asthma group were higher than those of non-asthma group [ ( 68. 19 ±43. 00) ppb vs ( 19. 52 ±10. 60) ppb, P lt; 0. 05] . A linear correlation of FeNO with lnPD20 FEV1 was revealed in the cases with AHR. Area under ROC curve was 0. 9. The optimal diagnostic cutoff point was 36. 5 ppb which was capable of differentiating asthma and non-asthma with sensitivity of 92. 7% ,specificity of 83. 3% , positive predictive value of 79. 17% , negative predictive value of 94. 34% and accuracy of 87. 13% . Conclusion FeNO test may be helpful in the diagnosis of asthma with high sensitivity and specificity.
Objective To review literatures regarding the diagnosis of asthma with the measurement of exhaled nitric oxide( eNO) and assess the effectiveness and accuracy of eNO in the diagnosis of asthma.Methods MEDLINE, OVID, CBMdisc, CNKI( 1991 to 2008) for studies involving the diagnostic value of eNO were searched, and references of included studies were also hand searched. QUADAS ( Quality Assessment of Diagnostic Accuracy Studies) items were used for quality assessment in the systematic review. Meta-disc software was used to analyze heterogeneity. Sensitivity, specificity and summary diagnostic odds ratio( SDOR) were used for the pooled analysis. The summary receiver operating characteristic ( SROC)curves were drew and the summary areas under the SROC ( SAUC) were calculated. Finally, sensitivity analysis was performed. Results Eleven literatures with15 studies were included. These 15 studies had well controlled the bias of partial verification, differential verification, incorporation and withdrawals. The possibility of the disease progression bias was less and the reference standard review could have a greater bias. The spectrumcomposition of a study, the inclusion and exclusion criteria and the reporting quality were poorly reported. In statistical analysis, the totally pooled sensitivity, pooled specificity, SDOR, SAUC of the measurement of eNO in the diagnosis of asthma was 0. 68, 0. 79, 12. 73, 0. 8446, respectively. Sensitivity analysis demonstrated no disproportionate influences of individual study. Conclusions eNO has a certain value in the diagnosis of asthma. To make further analysis, more studies with high quality are needed.
Objective Chronic obstructive pulmonary disease( COPD) is highly heterogeneous. In theory, the patients with same clinical manifestations, treatment response and prognosis can be classified into one phenotype, which may have same biological or physiological mechanisms. In this study the profiles of patients with COPD including body mass index( BMI) , Goddard score, fractional exhaled nitric oxide( FeNO) were analyzed in order to find some special phenotypes.Methods Patients with COPD at stable stage in Ruijin Hospital from May 2011 to February 2012 were evaluated with COPD assessment test ( CAT) in Chinese version, St. George’s Respiratory Questionnaire( SGRQ) , hospital anxiety and depression( HAD) rating scale, pulmonary function test, and 6-minute walking test ( 6MWT) . Baseline data was collected including height, weight, drug use, times of exacerbation, etc. Results A total of 126 patients were recruited. The patients with low BMI had poorer quality of life, lower FEV1 , poorer diffusion function, and higher Goddard score, and was easier to develop anxiety and depression. The patients with high BMI had lower oxygen saturation at rest. We failed to define a certain kind of phenotype according to FeNO. The patients of emphysema phenotype( assessed by Goddard score) had lower BMI, decreased lung diffusion capacity, and poorer quality of life. Conclusion The study can define COPD patients into some special phenotypes( low BMI and emphysema phenotype) , but failed to define a certain kind of phenotype according to FeNO.
Objective To compare the value of fractional exhaled nitric oxide ( FENO) measurement and leukotriene D4 bronchial provocation test ( LTD4-BPT) in diagnosis and evaluation of asthma. Methods 20 uncontrolled,22 partially controlled, 20 controlled asthmatics, and 21 normal subjects were enrolled in the study. Measurement of FENO was performed followed by LTD4-BPT. The distribution characteristics and relationship of both results were analyzed, and the diagnostic value was compared using receiver operation characteristic ( ROC) curve.Results FENO was above 25. 0ppb in 80. 7% of the asthmatics. The proportion of asthmatics with FENO between 26.0ppb and 49.0ppb was larger in the uncontrolled and partially controlled subjects than that in the controlled subjects. Both the median and interquartile range of cumulative dosage ( PD20FEV1-LTD4) were much higher in the controlled asthmatics as compared with the uncontrolled and partially controlled asthmatics. The area under the ROC curve ( AUC) for PD20FEV1-LTD4 [ AUC: 0.914, 95% CI: ( 0.855, 0.974) ] was larger than that of FENO [ AUC: 0.820, 95% CI: ( 0.718, 0.921) ] . Higher sensitivity ( 0.8570 vs. 0.8065) and specificity ( 0.9048 vs. 0.7619) were in favor of PD20 FEV1 -LTD4 ≤ 4.800 nmol as compared with FENO ≥ 26.0ppb being the positive threshold. Conclusion Compared with FENO measurement, LTD4-BPT has higher sensitivity and specificity and is of higher diagnostic value for asthma.
ObjectiveTo observe the effect of Budesonide formoterol inhalant on teenager patients with allergic rhinitis accompanied with asthma. MethodsForty-five teenager patients with allergic rhinitis accompanied with asthma treated between January 2012 and December 2013 were randomly divided into general treatment group, budesonide group and budesonide formoterol group, with 15 patients in each. Another 15 subjects undergoing physical examination were designated as the control group. Besides routine treatment, the budesonide group was also treated with budesonide inhalation at 100-200 μg twice a day, and the budesonide formoterol group was also treated with budesonide formoterol inhalation at 160 μg and 4.5 μg twice a day. The course of treatment lasted for four weeks. The patients were followed up for four weeks after the use of medicine halted. After treatment, exhaled nitric oxide (NO) examination were performed. ResultsThe amount of NO in the exhaled gas in all the three treatment groups were significantly different from the control group (P<0.05), and it was also significantly different between the Budesonide group and the budesonide formoterol group (P<0.05). ConclusionBudesonide formoterol inhalant has a good effect on teenager patients with allergic rhinitis accompanied with asthma in terms of improving exhaled NO.
Objective To investigate the clinical characteristics of allergic and non-allergic asthma in Chinese adult asthmatic patients. Methods Consecutive treatment-naive adult outpatients with asthma were retrospectively analyzed in West China Hospital, Sichuan University from October 2014 to June 2016. The patients were classified into a non-allergic asthma (NAAS) group and an allergic asthma (AAS) group by skin prick test or antigen-specific IgE test. The differences between allergic and non-allergic asthma were compared in respect of gender, age, asthma control test (ACT) score, lung function, fractional exhaled nitric oxide (FeNO) level, body mass index (BMI), disease severity,etc. Results A total of 131 patients were enrolled in which 72 cases (54.96%) were allergic asthmatics and 59 cases (45.04%) were non-allergic asthmatics. The level of FeNO was statistically different (t=–2.762,P=0.007) between the NAAS group and the AAS group [(51.1±32.6)ppbvs. (69.1±41.7)ppb]. Seventeen cases of the NAAS group and 48 cases of the AAS group were complicated with rhinitis with statistically significant difference (χ2 =19.396,P=0.000). Airway limitation reversibility test showed that there were 37 cases in AAS and 20 cases in NAAS with no airway obstruction (NAO), 26 cases in AAS and 22 cases in NAAS with reversible airflow obstruction (RAO), 9 cases in AAS and 17 cases in NAAS with irreversible airflow obstruction (IAO), respectively, with statistically significant difference between two groups (Z=–2.461,P=0.014). There were 20 cases (33.9%) in NAAS and 37 cases (51.4%) in AAS with mild intermittent or persistent asthma, 18 cases (30.5%) in NAAS and 19 cases (26.4%) in AAS with moderate persistent asthma, 21 cases (35.6%) in NAAS and 16 (22.2%) in AAS with severe persistent asthma, respectively, with statistically significant difference (Z=–2.115,P=–0.034). The age, ACT score, FEV1%pred, and BMI had no statistical difference between two groups (allP>0.05). Conclusion Compared with allergic asthma, non-allergic asthma has less rhinitis, lower FeNO levels and higher prevalence of irreversible airflow obstruction.
Detection of the fraction of exhaled nitric oxide (FeNO) is a safe, simple and easy method to assess airway inflammation noninvasively. Thus, FeNO detection has been paid more attention to diagnosis and guide treatment of pulmonary diseases. The common feature of pneumonia, asthma, chronic obstructive pulmonary disease and chronic cough is the existence of varying degrees of airway inflammation. In this review, FeNO production and its potential pathologic and physiologic role in various pulmonary diseases were discussed.