Sayão Larissa Bouwman, de Britto Murilo Carlos Amorim, Burity Edjane, Rattes Catarina, Reinaux Cyda Maria Albuquerque, Fink James, Dornelas de Andrade Armèle
Department of Physiotherapy, Universidade Federal de Pernambuco, Recife, Brazil.
Department of Pediatric Pneumology, Instituto de Medicina Integral Fernando Figueira - IMIP, Recife, Brazil.
Respir Med. 2016 Apr;113:15-21. doi: 10.1016/j.rmed.2016.02.008. Epub 2016 Feb 22.
Airways inflammation may precede pulmonary dysfunction in wheezing individuals. The fraction of exhaled nitric oxide (FENO) has been described as a useful method for wheezing diagnosis in children, however, its application requires evidence. This study aimed to determine the accuracy of FENO in identifying wheezing in preschoolers.
A cross-sectional study was carried out with children from 3 to 5 years old, from Brazilian day care centers and public schools. They were evaluated by FENO measurement through the single breath method, and by ATS-DLD-78-C questionnaire that is used as a gold standard to phenotype wheezing patterns.
The sample consisted of 243 non-wheezing children, 118 non-recurrent wheezing and 62 recurrent wheezing. The means of FENO and confidence intervals of 95%, were 5.4 (CI 95%, 5.2-5.6); 7.5 (CI 95%, 6.9-8.2) and 11.2 (CI 95%, 9.6-12.7), respectively. The sensitivity, specificity, positive and negative predictive FENO values in the 6 parts per billion (ppb) cut-off point that best diagnosed wheezing of non-wheezing children, were: 65.5%, 84.3%, 75.6% and 76.7%, respectively, with an area under the curve (AUC) = 0.77. At 10 ppb, the best cut-off points for differentiating recurrent wheezing of non-recurrent wheezing were: 56.4%, 81.3%, 61.4%, 78.0%, respectively, with an AUC = 0.69. The post-test probability for each FENO cut-off points was increased by 33% for wheezing and 20% for recurrent wheezing diagnosis when associated with clinical examination.
FENO can provide a reliable and accurate method to discriminate the presence and type of wheezing in preschoolers with 92% of acceptable in this study population.
气道炎症可能先于喘息个体出现肺功能障碍。呼出一氧化氮分数（FENO）已被描述为儿童喘息诊断的一种有用方法，然而，其应用需要证据支持。本研究旨在确定FENO在识别学龄前儿童喘息方面的准确性。
对来自巴西日托中心和公立学校的3至5岁儿童进行了一项横断面研究。通过单呼吸法测量FENO对他们进行评估，并通过ATS-DLD-78-C问卷作为喘息模式表型分析的金标准。
样本包括243名非喘息儿童、118名非复发性喘息儿童和62名复发性喘息儿童。FENO的平均值及95%置信区间分别为5.4（CI 95%，5.2 - 5.6）；7.5（CI 95%，6.9 - 8.2）和11.2（CI 95%，9.6 - 12.7）。在能最佳诊断非喘息儿童喘息的十亿分之六（ppb）截断点时，FENO的敏感性、特异性、阳性和阴性预测值分别为：65.5%、84.3%、75.6%和76.7%，曲线下面积（AUC） = 0.77。在10 ppb时用于区分非复发性喘息和复发性喘息的最佳截断点分别为：56.4%、81.3%、61.4%、78.0%，AUC = 0.69。与临床检查相关时，每个FENO截断点的检验后概率在喘息诊断时提高了33%，在复发性喘息诊断时提高了20%。
FENO可为鉴别学龄前儿童喘息的存在及类型提供一种可靠且准确的方法，在本研究人群中有92%是可接受的。
