Open AccessExhaled nitric oxide indicates poorly athlete's asthma
Author(s) -
Voutilainen Mikko,
Malmberg Leo Pekka,
Vasankari Tommi,
Haahtela Tari
Publication year - 2013
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.12014
Subject(s) - medicine , exhaled nitric oxide , asthma , provocation test , methacholine , area under the curve , receiver operating characteristic , bronchial hyperresponsiveness , confidence interval , spirometry , athletes , elite athletes , physical therapy , respiratory disease , lung , pathology , alternative medicine
In athletes, exercise‐induced respiratory symptoms are common and their assessment is time and resource consuming. Objective The objective was to evaluate fractional concentration of exhaled nitric oxide ( FENO ) as a predictor of bronchial hyperresponsiveness ( BHR ) and of asthma. Materials and Methods Eighty‐seven elite athletes and a control group of 87 sedentary patients with symptoms suggesting asthma underwent measurements of FENO and of BHR by using methacholine provocation test ( MCH ) and eucapnic voluntary hyperpnoea ( EVH ) (athletes) or histamine provocation test ( HIST ) (controls). Results In athletes, elevated FENO (>30 ppb) was not associated with lung function‐confirmed asthma or with MCH positivity, but receiver operating characteristics ( ROC ) analysis showed some predictive value for EVH positivity [Area Under Curve ( AUC ) 0.652, 95% confidence interval ( CI ): 0.53 to 0.78, P = 0.020]. However, the sensitivity (55%) and the specificity (71%) were poor. In sedentary patients, FENO was significantly associated with both confirmed asthma and HIST positivity, ROC analysis showing FENO to be significantly predictive for HIST positivity ( AUC 0.83, 95% CI : 0.70 to 0.96, P = 0.001) and for asthma ( AUC 0.74, 95% CI : 0.63 to 0.85, P < 0.001). Conclusion The results suggest that in contrast to sedentary patients, FENO seems to be a poor predictor of BHR and of clinical asthma in elite athletes. We find it unlikely that FENO could be a useful screening tool in athletes with exercise‐induced respiratory symptoms.