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Original Research: COUGH |

Exhaled Nitric Oxide Measurement Is Useful for the Exclusion of Nonasthmatic Eosinophilic Bronchitis in Patients With Chronic Cough

Mi-Jung Oh, MD; Jin-Young Lee, MD; Byung-Jae Lee, MD, PhD; Dong-Chull Choi, MD, PhD
Author and Funding Information

*From the Department of Medicine (Dr. Oh), Bundang Jesaeng Hospital, Seongnam; and Department of Medicine (Drs. J-Y Lee, B-J Lee, and Choi), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Correspondence to: Dong-Chull Choi, MD, PhD, Division of Allergy, Department of Medicine, Samsung Medical Center, 50 Ilwon-dong, Kangnam-gu, Seoul, Korea, 135-710; e-mail: dcchoi@skku.edu


This study was supported by a Samsung Medical Center Clinical Research Development Program grant, #CRS-106-22-1.

With the exception of the above financial support, the authors have declared that no conflicts of interest exist.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(5):990-995. doi:10.1378/chest.07-2541
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Background:  Nonasthmatic eosinophilic bronchitis (NAEB) is an important cause of chronic cough, and it can be diagnosed by an induced-sputum (IS) examination. However, an IS examination is a complex and time-consuming procedure, and it has limited clinical application. This study aimed to evaluate the role of exhaled nitric oxide (NO) for the investigation of chronic cough, especially of NAEB.

Methods:  Two hundred eleven nonsmoking patients with a cough lasting > 3 weeks were enrolled in the study. The patients were examined and investigated with conventional diagnostic tools, including an IS examination. Exhaled NO was measured by a chemoluminescent analyzer.

Results:  One hundred seventeen patients with adequate IS results were analyzed: asthma, n = 14; NAEB, n = 21; and “others,” n = 82. Exhaled NO and IS eosinophils were significantly higher in the asthma group and NAEB group than in the others group. Exhaled NO and IS eosinophils were significantly correlated in the asthma and NAEB groups. In the nonasthmatic group, the sensitivity and specificity of exhaled NO for detecting NAEB, using 31.7 parts per billion as the exhaled NO cutoff point, were 86% and 76%, respectively. Positive and negative predictive values were 47% and 95%, respectively, and positive and negative likelihood ratios were 3.51 and 0.19, respectively.

Conclusion:  We concluded that exhaled NO measurement may be useful as part of the initial evaluation for chronic cough, especially for the exclusion of NAEB. A low level of exhaled NO suggested little likelihood of NAEB for the nonasthmatic patients with chronic cough.

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