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Exhaled nitric oxide and mannitol test to predict exercise‐induced bronchoconstriction
Author(s) -
Kim Kyubo,
Cho Hong Je,
Yoon Jung Won,
Choi Sun Hee,
Sheen Youn Ho,
Han Man Yong,
Baek Heysung
Publication year - 2018
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13599
Subject(s) - medicine , mannitol , exhaled nitric oxide , bronchoconstriction , area under the curve , provocation test , asthma , treadmill , gastroenterology , anesthesia , pathology , biochemistry , chemistry , alternative medicine
Background Exercise‐induced bronchoconstriction ( EIB ) is diagnosed via exercise challenge on a treadmill, but such testing requires complex equipment and sufficient health‐care resources. The fraction of exhaled nitric oxide (Fe NO ) test and mannitol bronchial provocation test ( BPT ) may serve as a surrogate for exercise testing. Methods We compared the diagnostic utilities of the Fe NO test and mannitol BPT in predicting EIB in asthmatic children. We retrospectively analyzed data from 60 asthmatic children aged 6–16 years. We compared the exercise BPT results, Fe NO levels, and mannitol BPT data. Results All subjects were divided into exercise‐positive ( n = 41) or ‐negative ( n = 19) BPT groups. Of the 41 exercise‐positive patients, 32 were mannitol BPT positive and nine were mannitol BPT negative. Of the 19 exercise‐negative patients, nine and 10, respectively, were mannitol BPT positive and BPT negative. The maximum % forced expiratory volume in 1 s ( FEV 1 ) decrease after exercise was positively correlated with Fe NO ( r = 0.556, P < 0.001), and with mannitol response–dose ratio ( RDR ; r = 0.416, P = 0.001). The receiver operating characteristic ( ROC ) curve for Fe NO to discriminate between asthmatic subjects with and without EIB had an area under the curve ( AUC ) of 0.771 (95% CI : 0.643–0.870). The discriminatory ROC curve for mannitol RDR had an AUC of 0.763 (95% CI : 0.633–0.864). The AUC of Fe NO and mannitol RDR did not differ significantly. Conclusions EIB significantly correlated with both Fe NO and mannitol BPT data. Given that both methods similarly predicted EIB in asthmatic children, the simpler and safer Fe NO test alone may be a clinically useful diagnostic tool.