Role of pulmonary function and FeNO detection in early screening of patients with ACO

Wang, Jing; Wang, Wenting; Lin, Huan; Cheng, Hui; Jiang, Shujuan; Dong, Lin; Cao, Naiqing; Ren, Hongsheng

doi:10.3892/etm.2020.8762

Cited by 5 publications

(6 citation statements)

References 31 publications

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“…The FEV1/FVC ratio, an important parameter of airflow obstruction, 25 was found to be significantly lower in patients with T2-CRSwNP(h) than in non-T2-CRSwNP(h) patients, and FeNO was negatively correlated with the FEV1/FVC ratio in patients with CRSwNP. The results of this study suggest that FeNO can serve as an effective marker for assessing airway obstruction in patients with CRSwNP.…”

Section: Discussionmentioning

confidence: 99%

The Role of Fractional Exhaled Nitric Oxide in Diagnosing Asthmatic Type 2 Chronic Rhinosinusitis With Nasal Polyps

Park

Cha

Yang

et al. 2023

Am J Rhinol�Allergy

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Background Fractional exhaled nitric oxide (FeNO) is useful in the management of asthma and predicting the efficacy of standard corticosteroids and biologics. However, the diagnostic value of FeNO in asthmatic chronic rhinosinusitis with nasal polyps (CRSwNP) remains unclear. Objective We assessed FeNO levels in patients with CRSwNP and evaluated the diagnostic value of FeNO for screening type 2 CRSwNP (T2-CRSwNP) with asthma. Methods We enrolled 94 patients who were diagnosed with CRSwNP and underwent functional endoscopic sinus surgery. FeNO levels, the blood eosinophil percentage, total IgE, spirometry tests (FEV1/FVC), Lund–Mackay CT score, and percentage of patients with comorbid asthma were compared among CRSwNP subgroups. Spearman rank correlation test was used to assess the degree of association between variables. ROC curve analysis was conducted to evaluate the diagnostic capability to differentiate T2-CRSwNP based on clinical and histological classifications. Results FeNO levels and the blood eosinophil percentage were significantly higher in patients with T2-CRSwNP(h) based on histological data ( P < .05). FeNO was correlated with the blood eosinophil percentage ( r = 0.420, P < .001) and FEV1/FVC ( r = −0.324, P = .001). A FeNO level of 27 ppb had a good ability to discriminate patients with asthmatic T2-CRSwNP(h) (AUC = 0.848; 95% CI = 0.7602-0.9361; sensitivity = 90.9%; specificity = 63.9%). The optimal cutoff values for FeNO and the blood eosinophil percentage for diagnosing asthmatic T2-CRSwNP(h) were 68 ppb and 5.6% (sensitivity = 95.5%; specificity = 86.1%; AUC = 0.931; 95% CI = 0.8832-0.9791). In the diagnosis of severe T2-CRSwNP(c) based on clinical data, a FeNO level of 36 ppb showed the highest AUC (0.816; 95% CI = 0.7173-0.914; sensitivity = 72.7%; specificity = 79.2%). Conclusion FeNO is a useful marker for screening asthmatic T2-CRSwNP even prior to biopsy or asthma evaluation and may assist in selecting a proper treatment.

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Section: Discussionmentioning

confidence: 99%

The Role of Fractional Exhaled Nitric Oxide in Diagnosing Asthmatic Type 2 Chronic Rhinosinusitis With Nasal Polyps

Park

Cha

Yang

et al. 2023

Am J Rhinol�Allergy

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“…An increased neutrophil count in the sputum of ACO patients who were mostly ex-smokers was suggested to be a promising ACO-specific marker [43]. However, their sputum eosinophil level was equivalent to that in asthma patients [44], and thus FeNO may not be a helpful indicator for distinguishing ACO and asthma.…”

Section: Discussionmentioning

confidence: 99%

Higher Prevalence and Severity of Eosinophilic Otitis Media in Patients with Asthma-COPD Overlap Compared with Asthma Alone

Sato,

Seo,

Tagaya

et al. 2023

Int Arch Allergy Immunol

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Introduction: Eosinophilic otitis media (EOM) is well-known to frequently co-exist with adult-onset asthma. Both diseases are similar type 2 inflammation and are considered to have a “one airway, one disease” relationship. Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO), characterized by airway obstruction caused by airway wall thickening (AWT), is a severe condition with a higher incidence of mortality compared to asthma alone or COPD alone. Based on the “one airway, one disease” concept, we hypothesized that the inflammatory pathophysiology of EOM differs depending on its comorbidity with ACO or with asthma alone. Methods: A total of 77 chronic rhinosinusitis (CRS) patients with asthma were enrolled in this study. The subjects were divided into 2 groups: a group with comorbid asthma alone (asthma group; 46 patients), and a group with comorbid ACO (ACO group; 31 patients). The 2 groups were compared and assessed with regard to various factors, including the patients’ clinical characteristics, prevalence rate of EOM, EOM severity, EOMs relationships with smoking and AWT, and the eosinophil and neutrophil cell counts in the middle ear effusion (MEE). Results: The ACO group included significantly more males (p < 0.05), was significantly older (p < 0.05), and showed significantly lower lung function values (FEV1 [L], FEV1 [%pred]) (p < 0.01) compared with the asthma group. The ACO group also had a significant history of smoking as shown by the Brinkman index (p < 0.01) and greater AWT as assessed by high-resolution computed tomography (p < 0.05). The EOM prevalence rate was significantly higher in the ACO group (p < 0.05), especially with increased ACO severity (p < 0.05). The EOM severity was also significantly higher in the ACO group (p < 0.05) and also correlated with the ACO severity (p < 0.05). The pretreatment ear clinical characteristics score and the average air conduction hearing level were significantly higher in the ACO group (p < 0.05). The eosinophil percentage in the MEE/otorrhea was significantly lower in the ACO group (25.3%) than in the asthma group (54.7%) (p < 0.05). Conversely, the neutrophil percentage was significantly higher in the ACO group (75.7% vs. 41.9%) (p < 0.05). Conclusions: Our findings suggest that, in CRS patients with asthma, comorbidity with ACO may be a clinical factor leading to increased EOM prevalence and severity, as well as a higher neutrophil infiltration percentage in the middle ear. Cessation of smoking and early therapeutic intervention for ACO may mitigate progression of bronchial remodeling (i.e., reduce AWT) and help reduce the prevalence and severity of EOM.

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“…However, it is unclear which one is more suitable in diagnosing ACO. Although the positive BDT result alone is limited in differentiating between asthma, COPD, and ACO, COPD has a lower ΔFEV 1 (in mL) than asthma and ACO, and bronchodilator response (BDR) was helpful in the early screening of ACO [ 25 ]. Besides, BDR was vital in identifying different phenotypes of ACO [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…The two aforementioned studies showed a low sensitivity, indicating that FeNO alone is useful but difficult to use for differentiating between ACO and COPD. Recently, Wang reported that ΔFEV 1 and FeNO were significantly different in ACO compared with COPD alone, which indicated that BDR combined with FeNO may be helpful in the early screening of ACO [ 25 ]. However, there is still a lack of an optimal value of ΔFEV 1 for differentiating between asthma, COPD, and ACO in patients with a positive BDT result.…”

Section: Introductionmentioning

confidence: 99%

The value of bronchodilator response in FEV1 and FeNO for differentiating between chronic respiratory diseases: an observational study

Gong,

Huang,

et al. 2024

Eur J Med Res

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Background There is no uniform standard for a strongly positive bronchodilation test (BDT) result. In addition, the role of bronchodilator response in differentiating between asthma, chronic obstructive pulmonary disease (COPD), and asthma–COPD overlap (ACO) in patients with a positive BDT result is unclear. We explored a simplified standard of a strongly positive BDT result and whether bronchodilator response combined with fractional exhaled nitric oxide (FeNO) can differentiate between asthma, COPD, and ACO in patients with a positive BDT result. Methods Three standards of a strongly positive BDT result, which were, respectively, defined as post-bronchodilator forced expiratory volume in 1-s responses (ΔFEV1) increasing by at least 400 mL + 15% (standard I), 400 mL (standard II), or 15% (standard III), were analyzed in asthma, COPD, and ACO patients with a positive BDT result. Receiver operating characteristic curves were used to determine the optimal values of ΔFEV1 and FeNO. Finally, the accuracy of prediction was verified by a validation study. Results The rates of a strongly positive BDT result and the characteristics between standards I and II were consistent; however, those for standard III was different. ΔFEV1 ≥ 345 mL could predict ACO diagnosis in COPD patients with a positive BDT result (area under the curve [AUC]: 0.881; 95% confidence interval [CI] 0.83–0.94), with a sensitivity and specificity of 90.0% and 91.2%, respectively, in the validation study. When ΔFEV1 was < 315 mL combined with FeNO < 28.5 parts per billion, patients with a positive BDT result were more likely to have pure COPD (AUC: 0.774; 95% CI 0.72–0.83). Conclusion The simplified standard II can replace standard I. ΔFEV1 and FeNO are helpful in differentiating between asthma, COPD, and ACO in patients with a positive BDT result.

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Role of pulmonary function and FeNO detection in early screening of patients with ACO

Cited by 5 publications

References 31 publications

The Role of Fractional Exhaled Nitric Oxide in Diagnosing Asthmatic Type 2 Chronic Rhinosinusitis With Nasal Polyps

The Role of Fractional Exhaled Nitric Oxide in Diagnosing Asthmatic Type 2 Chronic Rhinosinusitis With Nasal Polyps

Higher Prevalence and Severity of Eosinophilic Otitis Media in Patients with Asthma-COPD Overlap Compared with Asthma Alone

The value of bronchodilator response in FEV1 and FeNO for differentiating between chronic respiratory diseases: an observational study

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