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

Song, Woo-Jung; Won, Ha-Kyeong; Moon, Sung-Do; Chung, Soo-Jie; Kang, Sung-Yoon; Sohn, Kyoung-Hee; Kim, Ju-Young; Kim, Byung-Keun; Lim, Kyung-Hwan; Kim, Mi-Yeong; Yang, Min-Suk; Park, Heung-Woo; Chang, Yoon-Seok; Lee, Byung-Jae; Morice, Alyn H.; Cho, Sang-Heon

Abstract

© 2016 Background Fractional exhaled nitric oxide (FENO) is a safe and convenient test for assessing T H 2 airway inflammation, which is potentially useful in the management of patients with chronic cough. Objective To summarize the current evidence on the diagnostic usefulness of FENO for predicting inhaled corticosteroid (ICS) responsiveness in patients with chronic cough. Methods A 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. Results We 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 abou t 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. Conclusions We 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.

Citation

Song, W.-J., Won, H.-K., Moon, S.-D., Chung, S.-J., Kang, S.-Y., Sohn, K.-H., Kim, J.-Y., Kim, B.-K., Lim, K.-H., Kim, M.-Y., Yang, M.-S., Park, H.-W., Chang, Y.-S., Lee, B.-J., Morice, A. H., & Cho, S.-H. (2017). Could Fractional Exhaled Nitric Oxide Test be Useful in Predicting Inhaled Corticosteroid Responsiveness in Chronic Cough? A Systematic Review. The journal of allergy and clinical immunology. In practice, 5(1), 135-143.e1. https://doi.org/10.1016/j.jaip.2016.07.017

• Journal Article Type: Article
• Acceptance Date: Jul 18, 2016
• Online Publication Date: Oct 1, 2016
• Publication Date: Jan 1, 2017
• Deposit Date: Nov 14, 2016
• Publicly Available Date: Nov 14, 2016
• Journal: Journal of allergy and clinical immunology : in practice
• Print ISSN: 2213-2198
• Peer Reviewed: Peer Reviewed
• Volume: 5
• Issue: 1
• Pages: 135-143.e1
• DOI: https://doi.org/10.1016/j.jaip.2016.07.017
• Keywords: Chronic cough, Fractional exhaled nitric oxide, Corticosteroid responsiveness, Systematic review
• Public URL: https://hull-repository.worktribe.com/output/445078
• Publisher URL: http://www.sciencedirect.com/science/article/pii/S2213219816303191
• Additional Information: This article is maintained by: Elsevier; Article Title: Could Fractional Exhaled Nitric Oxide Test be Useful in Predicting Inhaled Corticosteroid Responsiveness in Chronic Cough? A Systematic Review; Journal Title: The Journal of Allergy and Clinical Immunology: In Practice; CrossRef DOI link to publisher maintained version: http://dx.doi.org/10.1016/j.jaip.2016.07.017; Content Type: article; Copyright: © 2016 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology
• Contract Date: Nov 14, 2016