Could Fractional Exhaled Nitric Oxide Test be Useful in Predicting Inhaled Corticosteroid Responsiveness in Chronic Cough? A Systematic Review

详细信息    查看全文

• 作者：Woo-Jung Song ; MD^a ; Ha-Kyeong Won ; MD^a ; Sung-Do Moon ; MD^a ; Soo-Jie Chung ; MD^a ; Sung-Yoon Kang ; MD^a ; Kyoung-Hee Sohn ; MD^a ; Ju-Young Kim ; MD^b ; Byung-Keun Kim ; MD^a ; Kyung-Hwan Lim ; MD^c ; Mi-Yeong Kim ; MD^d ; Min-Suk Yang ; MD ; PhD^a ; ^e ; Heung-Woo Park ; MD ; PhD^a ; Yoon-Seok Chang ; MD ; PhD^a ; ^f ; Byung-Jae Lee ; MD ; PhD^g ; Alyn H. Morice ; MD ; FRCP^h ; Sang-Heon Cho ; MD ; PhD^a ; ^{shcho@snu.ac.kr}
• 关键词：Chronic cough ; Fractional exhaled nitric oxide ; Corticosteroid responsiveness ; Systematic review
• 刊名：The Journal of Allergy and Clinical Immunology: In Practice
• 出版年：2017
• 出版时间：January-February 2017
• 年：2017
• 卷：5
• 期：1
• 页码：135-143.e1
• 全文大小：780 K
• 卷排序：5

文摘

Fractional exhaled nitric oxide (Feno) is a safe and convenient test for assessing TH2 airway inflammation, which is potentially useful in the management of patients with chronic cough.ObjectiveTo summarize the current evidence on the diagnostic usefulness of Feno for predicting inhaled corticosteroid (ICS) responsiveness in patients with chronic cough.MethodsA systematic literature review was conducted to identify articles published in peer-reviewed journals up to February 2015, without language restriction. We included studies that reported the usefulness of Feno (index test) for predicting ICS responsiveness (reference standard) in patients with chronic cough (target condition). The data were extracted to construct a 2 × 2 accuracy table. Study quality was assessed with Quality Assessment of Diagnostic Accuracy Studies 2.ResultsWe identified 5 original studies (2 prospective and 3 retrospective studies). We identified considerable heterogeneities in study design and outcome definitions, and thus were unable to perform a meta-analysis. The proportion of ICS responders ranged from 44% to 59%. Sensitivity and specificity ranged from 53% to 90%, and from 63% to 97%, respectively. The reported area under the curve ranged from about 0.60 to 0.87; however, studies with a prospective design and a lower prevalence of asthma had lower area under the curve values. None measured placebo effects or objective cough frequency.ConclusionsWe did not find strong evidence to support the use of Feno tests for predicting ICS responsiveness in chronic cough. Further studies need to have a randomized, placebo-controlled design, and should use validated measurement tools for cough. Standardization would facilitate the development of clinical evidence.