Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
Int Arch Allergy Immunol. 2022;183(7):762-769. doi: 10.1159/000522062. Epub 2022 Feb 14.
Chest tightness variant asthma (CTVA) in children presents with chest tightness as the sole manifestation. Diagnostic tests are needed given the lack of typical asthma symptoms. The present study aimed to investigate the diagnostic value of exercise challenge testing (ECT) and fractional exhaled nitric oxide (FeNO) in pediatric CTVA.
We included 98 children aged 6-13 years with chest tightness as the sole symptom for >4 weeks. All subjects underwent FeNO measurement, spirometry and ECT, and received 4-week budesonide/formoterol treatment. According to treatment responses, children were categorized into CTVA (n = 12) and non-CTVA (n = 86) groups. Differences in clinical characteristics and FeNO, spirometry, and ECT results were compared between the two groups. The FeNO and ECT diagnostic performances were determined using receiver operating characteristic (ROC) curve analysis.
Children with CTVA exhibited significantly higher Mycoplasma pneumoniae IgG, total IgE, and FeNO values; greater post-ECT forced expiratory volume in 1 s (FEV1) fall; and more frequent sensitization to mites and pets than those without CTVA. Further logistic regression revealed that higher FEV1 fall (OR, 1.39; 95% CI: 1.11-1.74; p = 0.004) and higher FeNO values (OR, 1.04; 95% CI: 1.01-1.08; p = 0.014) were risk factors associated with CTVA. FEV1 fall and FeNO had similar areas under the ROC curve (AUCs) (0.79 vs. 0.78; p = 0.924), and their optimal CTVA-prediction cutoff values were 9.9% and 15.0 ppb, respectively. The AUC of FEV1 fall and FeNO combination was higher at 0.86 (95% CI: 0.78-0.93); however, no difference was observed using the single test (p > 0.05). Their combination exhibited a relatively higher sensitivity than that of FEV1 fall alone (0.75 vs. 0.67) and higher positive predictive value than that of FeNO alone (0.60 vs. 0.29).
CTVA is a cause of unexplained recurrent chest tightness in children. FeNO ≥15.0 ppb and post-ECT FEV1 fall ≥9.9% are diagnostically valuable for CTVA in children, with their combination potentially contributing to greater diagnostic accuracy.
儿童以胸闷为唯一表现的胸闷变异型哮喘（CTVA）。由于缺乏典型的哮喘症状，需要进行诊断性检查。本研究旨在探讨运动激发试验（ECT）和呼出气一氧化氮分数（FeNO）在儿科 CTVA 中的诊断价值。
纳入 98 例以胸闷为主诉>4 周的 6-13 岁儿童。所有患者均行 FeNO 测定、肺功能检查和 ECT，并接受布地奈德/福莫特罗 4 周治疗。根据治疗反应，将患儿分为 CTVA（n=12）和非 CTVA（n=86）两组。比较两组间临床特征、FeNO、肺功能检查和 ECT 结果的差异。采用受试者工作特征（ROC）曲线分析评估 FeNO 和 ECT 的诊断效能。
CTVA 患儿肺炎支原体 IgG、总 IgE 和 FeNO 值较高，ECT 后 1 秒用力呼气量（FEV1）下降幅度较大，尘螨和宠物致敏率较高。进一步的 logistic 回归分析显示，FEV1 下降幅度更大（比值比，1.39；95%可信区间：1.11-1.74；p=0.004）和 FeNO 值更高（比值比，1.04；95%可信区间：1.01-1.08；p=0.014）是与 CTVA 相关的危险因素。FEV1 下降幅度和 FeNO 的 ROC 曲线下面积（AUC）相似（0.79 比 0.78；p=0.924），最佳 CTVA 预测截断值分别为 9.9%和 15.0 ppb。FEV1 下降幅度和 FeNO 联合的 AUC 为 0.86（95%可信区间：0.78-0.93），但单项检测差异无统计学意义（p>0.05）。FEV1 下降幅度和 FeNO 联合的敏感性高于 FEV1 下降幅度单独检测（0.75 比 0.67），阳性预测值高于 FeNO 单独检测（0.60 比 0.29）。
CTVA 是儿童不明原因反复发作性胸闷的病因之一。FeNO≥15.0 ppb 和 ECT 后 FEV1 下降≥9.9%对儿童 CTVA 具有诊断价值，两者联合应用可能有助于提高诊断准确性。
