Importance of fractional exhaled nitric oxide in diagnosis of bronchiectasis accompanied with bronchial asthma

Chen, Fengjia; Liao, Hai‐Han; Huang, Xinyan; Xie, Canmao

doi:10.21037/jtd.2016.03.72

Cited by 22 publications

(15 citation statements)

References 17 publications

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“…Since then, some studies have reported a direct link between bronchiectasis and bronchial hyperreactivity or atopy. [ 29 , 30 ] In our study, however, we did not identify a positive relationship between bronchiectasis and atopy. In addition, the higher level of serum eosinophils we observed in patients with coexistent bronchiectasis suggests that the presence of bronchiectasis could potentially be used to identify a phenotype of patients with severe eosinophilic asthma (SEA).…”

Section: Discussioncontrasting

confidence: 88%

Clinical features of asthma with comorbid bronchiectasis

Zhang¹,

Xiong²,

Wu³

et al. 2021

Medicine

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Background: This meta-analysis aimed to systematically estimate the prevalence of comorbid bronchiectasis in patients with asthma and to summarize its clinical impact. Methods: Embase, PubMed, and Cochrane Library electronic databases were searched to identify relevant studies published from inception until March 2020. Study Selection: Studies were included if bronchiectasis was identified by high-resolution computed tomography. Outcomes included the prevalence of bronchiectasis and its association with demographic characteristics and indicators of asthma severity, including results of lung function tests and the number of exacerbations. Results: Five observational studies with 839 patients were included. Overall, the mean prevalence of bronchiectasis in patients with asthma was 36.6% (307/839). Patients with comorbid bronchiectasis had lower forced expiratory volume in 1 second (FEV 1 )/forced vital capacity (FVC) (MD: −2.71; 95% CI: −3.72 to −1.69) and more frequent exacerbations (MD: 0.68; 95% CI: 0.03 to 1.33) than those with asthma alone, and there was no significant difference of sex, duration of asthma and serum levels of immunoglobulin(Ig)Es between asthmatic patients with or without bronchiectasis. Conclusion: The presence of bronchiectasis in patients with asthma was associated with greater asthma severity. There are important therapeutic implications of identifying bronchiectasis in asthmatic patients.

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Section: Discussioncontrasting

confidence: 88%

Clinical features of asthma with comorbid bronchiectasis

Zhang¹,

Xiong²,

Wu³

et al. 2021

Medicine

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“…In fact, few studies have assessed FeNo in subjects with asthma and bronchiectasis. In a recent retrospective study, Chen et al [ 61 ] measured FeNO levels in 99 patients with bronchiectasis (20 of them with asthma) and found higher FeNO levels in subjects with bronchiectasis and asthma, compared to subjects who had only bronchiectasis. The authors also demonstrated that FeNO levels can help distinguish patients with bronchiectasis and asthma from those with bronchiectasis but not asthma, and they established a cut-off point of 22.5 ppb, with an estimated AUC-ROC of 0.832.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with bronchiectasis in patients with uncontrolled asthma; the NOPES score: a study in 398 patients

et al. 2018

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BackgroundSome studies have reported a high prevalence of bronchiectasis in patients with uncontrolled asthma, but the factors associated with this condition are unknown. The objective of this study was to determine the prevalence of bronchiectasis in uncontrolled moderate-to-severe asthma and to identify risk factors and their correlation with bronchiectasis in these patients.MethodsThis is a prospective study of data from consecutive patients with uncontrolled moderate-to-severe asthma. Diagnosis of bronchiectasis was based on high-resolution computed tomography. A prognostic score was developed using a logistic regression model, which was used to determine the factors associated with bronchiectasis.ResultsA total of 398 patients (60% with severe asthma) were included. The prevalence of bronchiectasis was 28.4%. The presence of bronchiectasis was associated with a higher frequency of chronic expectoration (OR, 2.95; 95% CI, 1.49–5.84; p = 0.002), greater severity of asthma (OR, 2.43; 95% CI, 1.29–4.57; p = 0.006), at least one previous episode of pneumonia (OR, 2.42; 95% CI, 1.03–5.69; p = 0.044), and lower levels of FeNO (OR, 0.98; 95% CI, 0.97–0.99; p = 0.016). The NOPES score was developed on the basis of these variables (FeNO[cut off point 20.5 ppb], Pneumonia, Expectoration and asthma Severity), and it ranges from 0 to 4 points, where 0 means “no risk” and 4 corresponds to “high risk”. The NOPES score yielded an AUC-ROC of 70% for the diagnosis of bronchiectasis, with a specificity of 95%.ConclusionsAlmost a third of the patients with uncontrolled moderate-to-severe asthma had bronchiectasis. Bronchiectasis was related to the severity of asthma, the presence of chronic expectoration, a previous history of pneumonia, and lower levels of FeNO. The NOPES score is an easy-to-use scoring system with a high prognostic value for bronchiectasis in patients with uncontrolled moderate-to-severe asthma.

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“…symptoms alone, acute reversibility of airway obstruction, bronchial hyperresponsiveness, asthma biomarkers like exhaled nitric oxide (NO) or blood/sputum eosinophils). For instance, CHEN et al [119] suggested that exhaled NO could be a good biomarker to identify asthma in bronchiectasis patients but further investigation is needed to validate its use. In a large database of >150 patients, almost 20% of them had a sputum eosinophil percentage ⩾3%, suggesting some degree of airway eosinophilic inflammation [23].…”

Section: Asthma In Patients With Bronchiectasismentioning

confidence: 99%

The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions

et al. 2018

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Bronchiectasis is a clinical and radiological diagnosis associated with cough, sputum production and recurrent respiratory infections. The clinical presentation inevitably overlaps with other respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD). In addition, 4-72% of patients with severe COPD are found to have radiological bronchiectasis on computed tomography, with similar frequencies (20-30%) now being reported in cohorts with severe or uncontrolled asthma. Co-diagnosis of bronchiectasis with another airway disease is associated with increased lung inflammation, frequent exacerbations, worse lung function and higher mortality. In addition, many patients with all three disorders have chronic rhinosinusitis and upper airway disease, resulting in a complex "mixed airway" phenotype.The management of asthma, bronchiectasis, COPD and upper airway diseases has traditionally been outlined in separate guidelines for each individual disorder. Recognition that the majority of patients have one or more overlapping pathologies requires that we re-evaluate how we treat airway disease. The concept of treatable traits promotes a holistic, pathophysiology-based approach to treatment rather than a syndromic approach and may be more appropriate for patients with overlapping features.Here, we review the current clinical definition, diagnosis, management and future directions for the overlap between bronchiectasis and other airway diseases.

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Importance of fractional exhaled nitric oxide in diagnosis of bronchiectasis accompanied with bronchial asthma

Abstract: Clinical FeNO measurement is a simple, noninvasive, and rapid method used to differentiate asthmatic from nonasthmatic patients with BE. This technique exhibits potential for asthma management.

Cited by 22 publications

References 17 publications

Clinical features of asthma with comorbid bronchiectasis

Clinical features of asthma with comorbid bronchiectasis

Factors associated with bronchiectasis in patients with uncontrolled asthma; the NOPES score: a study in 398 patients

The overlap between bronchiectasis and chronic airway diseases: state of the art and future directions

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