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Original Research: Signs and Symptoms of Chest Diseases |

Validity of Fractional Exhaled Nitric Oxide in Diagnosis of Corticosteroid-Responsive Cough

Fang Yi, MD; Ruchong Chen, MD, PhD; Wei Luo, MSc; Danyuan Xu, MD; Lina Han, MD; Baojuan Liu, MD; Siqi Jiang, MD; Qiaoli Chen, BSc; Kefang Lai, MD, PhD
Author and Funding Information

Drs Yi and Chen contributed equally to this manuscript.

FUNDING/SUPPORT: This study was supported by National Natural Science Foundation of China [Grants 81070019 and 81000033].

CORRESPONDENCE TO: Kefang Lai, MD, PhD, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, 510120, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4):1042-1051. doi:10.1016/j.chest.2016.01.006
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Background  Whether fractional exhaled nitric oxide (FeNO) measurement alone or combined with sputum eosinophil and atopy is useful in predicting corticosteroid-responsive cough (CRC) and non-CRC (NCRC) is not clear.

Methods  A total of 244 patients with chronic cough and 59 healthy subjects as control were enrolled. The causes of chronic cough were confirmed according to a well-established diagnostic algorithm. FeNO measurement and induced sputum for differential cell were performed in all subjects.

Results  CRC occurred in 139 (57.0%) patients and NCRC occurred in 105. The FeNO level in CRC significantly correlated with sputum eosinophils (rs = 0.583, P < .01). The median (quarter) of FeNO level in CRC was significantly higher than NCRC (32.0 ppb [19.0-65.0 ppb] vs 15.0 ppb [11.0-22.0 ppb], P < .01). FeNO of 31.5 ppb had a sensitivity and specificity of 54.0% and 91.4%, respectively, in predicting CRC from chronic cough, with a positive predictive value of 89.3% and a negative predictive value of 60.0%. If the patients had a combination of low level of FeNO ( < 22.5 ppb), normal sputum eosinophil ( < 2.5%), and absence of atopy, the sensitivity and specificity would be 30.3% and 93.5% for predicting NCRC.

Conclusions  In our cohort, a high level (≥ 31.5 ppb) of FeNO indicates more likelihood of CRC, but the sensitivity is insufficient to rule out a diagnosis of CRC. A combination of low-level FeNO, normal sputum eosinophil, and absence of atopy suggests a lower likelihood of CRC.

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