Value of fractional exhaled nitric oxide combined with impulse oscillometry in the diagnosis of asthma in preschool children
GUAN Zhi-Yuan, FENG Yong, HAN Xiao-Hua
Department of Pediatric Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China (Han X-H, Email: hanxh5519@163.com)
Abstract Objective To evaluate the value of fractional exhaled nitric oxide (FeNO) combined with impulse oscillometry (IOS) in the diagnosis of asthma in preschool children, and to establish the optimal predictive model. Methods A retrospective analysis was performed on 156 children with wheezing, aged 3-5 years, who were admitted from September 2019 to December 2020. These children were divided into an asthma group with 52 children and a non-asthma group with 104 children. The two groups were compared in terms of IOS parameters, FeNO, and clinical data. The multivariate logistic regression analysis was used to establish the optimal predictive model. Results Compared with the non-asthma group, the asthma group had significantly higher total respiratory system impedance at 5 Hz (Z5), resistance of respiratory system at 5 Hz and 20 Hz (R5 and R20, respectively), resonance frequency, reactance area (AX), and FeNO and a significantly lower reactance difference at 5 Hz (P<0.05). The receiver operating characteristic (ROC) curve analysis showed that Z5, R5, R20, and FeNO had a certain value in the diagnosis of asthma (P<0.05). The multivariate logistic regression analysis established the optimal predictive model of R20+AX+FeNO, with an area under the ROC curve of 0.858 (P<0.05), a sensitivity of 78.8%, and a specificity of 76.9%. Conclusions FeNO combined with IOS is helpful for the diagnosis of asthma in preschool children, and the model of R20+AX+FeNO has a certain value in the diagnosis of asthma in these children. Citation:Chinese Journal of Contemporary Pediatrics, 2022, 24(9): 1020-1026
GUAN Zhi-Yuan,FENG Yong,HAN Xiao-Hua. Value of fractional exhaled nitric oxide combined with impulse oscillometry in the diagnosis of asthma in preschool children[J]. CJCP, 2022, 24(9): 1020-1026.
GUAN Zhi-Yuan,FENG Yong,HAN Xiao-Hua. Value of fractional exhaled nitric oxide combined with impulse oscillometry in the diagnosis of asthma in preschool children[J]. CJCP, 2022, 24(9): 1020-1026.
Pedersen SE, Hurd SS, Lemanske RF, et al. Global strategy for the diagnosis and management of asthma in children 5 years and younger[J]. Pediatr Pulmonol, 2011, 46(1): 1-17. PMID: 20963782. DOI: 10.1002/ppul.21321.
3 Global Initiative for Asthma. Global strategy for asthma management and prevention (update 2021)[EB/OL]. (2021-04-28)[2022-03-29]. https://ginasthma.org/wp-content/uploads/2021/04/GINA-2021-Main-Report_FINAL_21_04_28-WMS.pdf.
Sol IS, Kim YH, Kim S, et al. Assessment of within-breath impulse oscillometry parameters in children with asthma[J]. Pediatr Pulmonol, 2019, 54(2): 117-124. PMID: 30536749. DOI: 10.1002/ppul.24201.
Medeiros D, Castro P, Bianca ACD, et al. Impulse oscillometry: pulmonary function assessment in preschool children[J]. Expert Rev Respir Med, 2020, 14(12): 1261-1266. PMID: 32852224. DOI: 10.1080/17476348.2020.1813573.
Guo FH, Comhair SA, Zheng S, et al. Molecular mechanisms of increased nitric oxide (NO) in asthma: evidence for transcriptional and post-translational regulation of NO synthesis[J]. J Immunol, 2000, 164(11): 5970-5980. PMID: 10820280. DOI: 10.4049/jimmunol.164.11.5970.
12 National Institute for Health and Care Excellence. Asthma: diagnosis, monitoring and chronic asthma management[EB/OL]. (2021-03-22)[2022-03-29]. https://www.nice.org.uk/guidance/ng80.
Liu L, Liu W, Liu C, et al. Study on small airway function in asthmatics with fractional exhaled nitric oxide and impulse oscillometry[J]. Clin Respir J, 2018, 12(2): 483-490. PMID: 27606596. DOI: 10.1111/crj.12548.
Zeng J, Chen Z, Hu Y, et al. Asthma control in preschool children with small airway function as measured by IOS and fractional exhaled nitric oxide[J]. Respir Med, 2018, 145: 8-13. PMID: 30509720. DOI: 10.1016/j.rmed.2018.10.009.
Wang EE, Milner RA, Navas L, et al. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections[J]. Am Rev Respir Dis, 1992, 145(1): 106-109. PMID: 1731571. DOI: 10.1164/ajrccm/145.1.106.
Bokov P, Bafunyembaka G, Medjahdi N, et al. Cross-sectional phenotyping of small airway dysfunction in preschool asthma using the impulse oscillometry system[J]. J Asthma, 2021, 58(5): 573-585. PMID: 31958254. DOI: 10.1080/02770903.2020.1719133.
Lauhkonen E, Riikonen R, T?rm?nen S, et al. Impulse oscillometry at preschool age is a strong predictor of lung function by flow-volume spirometry in adolescence[J]. Pediatr Pulmonol, 2018, 53(5): 552-558. PMID: 29484853. DOI: 10.1002/ppul.23977.
Chen L, Wu L, Lu D, et al. The value of fractional exhaled nitric oxide and impulse oscillometric and spirometric parameters for predicting bronchial hyperresponsiveness in adults with chronic cough[J]. J Asthma Allergy, 2021, 14: 1065-1073. PMID: 34447255. PMCID: PMC8384260. DOI: 10.2147/JAA.S326879.
Deng X, Ma J, Yuan Y, et al. Association between overweight or obesity and the risk for childhood asthma and wheeze: an updated meta-analysis on 18 articles and 73 252 children[J]. Pediatr Obes, 2019, 14(9): e12532. PMID: 31033249. DOI: 10.1111/ijpo.12532.
WANG Hui-Min, LIU Chuan-He, LIU Chang-Shan, WANG Ying, HAN Zhi-Ying, SUN Xin, CHEN Xing, AN Shu-Hua, DUOLIKUN Muzhapaer, LU Ai-Ping, WANG Min, CHENG Yan, YIN Xiao-Mei, LIU Han-Min, WANG Hong, HUA Shan, DONG Li, HUANG Ying, JIANG Yi, XIONG Jian-Xin, DING Sheng-Gang, ZHAO Shun-Ying, WANG Jin-Rong, HUANG Gui-Min, MU Jing-Hui, CHEN Yu-Zhi. Efficacy of Huaiqihuang granules as adjuvant therapy for bronchial asthma in children: a real-world study[J]. CJCP, 2021, 23(9): 877-881.