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FENOMEDA

Fractional Exhaled Nitric Oxide measurement for diagnosing asthma and predicting steroid responsiveness - a systematic review

 

Projektleiter: Antonius Schneider, Klinikum rechts der Isar der Technischen Universität München

Förderung: BMBF

Beteiligte: Dr. rer. nat. Gerta Rücker, Dipl. Math Harriet Sommer

 

Beschreibung

Asthma is a common chronic disease with a high prevalence of approx. 5%. It is characterised by a
chronic inflammation process which induces bronchial hyper-responsiveness (BHR) and usually
reversible airway obstruction. Spirometry is the reference standard for diagnosing airway obstruction. In
mild asthma, airway obstruction is often not present, thus leading to diagnostic uncertainty. In that case,
bronchial provocation remains as a reference standard for determining BHR. However, bronchial
provocation is only available in specialised centres and carries a small risk of inducing severe
bronchospasm. Patients with asthma have high levels of nitric oxide in their exhaled breath which
correlates with the inflammation process and steroid responsiveness. Measurement of fractional exhaled
nitric oxide (FENO) is a non-invasive method for diagnosing asthma. Increased FENO concentrations
have been found in asthmatic patients including those with mild disease. It has been claimed that FENO
measurement would help to make or exclude asthma safely and fast without performing bronchial
provocation. Due to the heterogeneous results it remains unclear, how to interpret test results of FENO
measurement in terms of diagnosing asthma and to determine steroid responsiveness. The
recommended cut-off values are based on single study results, which are summarized in a narrative
way. The aim of the systematic review is to investigate the diagnostic accuracy of FENO measurement
for diagnosing asthma and to determine the diagnostic accuracy for predicting steroid responsiveness.

 

Publications:

  1. Stefan Karrasch, Klaus Linde, Gerta Rücker, Harriet Sommer, Margit Karsch-Völk, Jos Kleijnen, Rudolf A. Jörres, and Antonius Schneider, "Accuracy of FENO for diagnosing asthma: a systematic review", Thorax, vol. 72, no. 2, pp. 109-116, 2017.
  2. Antonius Schneider, Klaus Linde, Johannes B. Reitsma, Susanne Steinhauser, and Gerta Rücker, "A novel statistical model for analyzing data of a systematic review generates optimal cut-off values for fractional exhaled nitric oxide for asthma diagnosis ", Journal of Clinical Epidemiology, pp. pii: S0895-4356(17)30278-0, Sep 12 2017. [Published online]