Meta-analysis of exhaled nitric oxide (FeNO) with or without blood eosinophils for asthma diagnosis in adults

<bold>RATIONALE:</bold> Asthma diagnosis is challenging as spirometry and bronchial provocation tests (BPT) are often non-diagnostic or inaccessible. Type-2 biomarkers identify high-risk, treatment-responsive phenotypes, but their diagnostic value is unclear. <bold>AIM:</bold> Assess FeNO-alone or FeNO plus a blood eosinophil count (FeNO+BEC) for asthma diagnosis. <bold>METHODS:</bold> A systematic review of studies of FENO±BEC for asthma diagnosis based on bronchodilator response and BPT (methacholine-equivalent PC20<8mg⋅ml⁻¹/PD20<200μg = positive) was conducted. Meta-analysis used multiple-threshold (FeNO-alone) and bivariate random effects (FeNO+BEC) models in adults. Receiver operating characteristics’ area under the curve (AUC) and thresholds with positive likelihood ratio (+LR>10) and specificity (>90%) were determined with 95% confidence intervals (CI). PRISMA was followed. <bold>RESULTS:</bold> Of 3957 studies, 17 (n=4520) assessed FeNO, while 5 (n=2689) assessed FeNO+BEC. FeNO showed good diagnostic accuracy (AUC 0.80 [95%CI: 0.75-0.84]); at >46ppb, specificity was 96 [95-98]%, +LR 10.1 [6.29-16.34]. FeNO+BEC modestly increased AUC: 0.84 [0.83-0.86](Figure). <bold>CONCLUSION:</bold> FeNO alone demonstrates good diagnostic accuracy for asthma, with FeNO>46 ppb ruling in the diagnosis. Combining FeNO+BEC did not significantly increase test accuracy. Using FeNO may accelerate and improve diagnostic trajectories. <bold>PROSPERO</bold>#CRD42023489738; <bold>FUNDING:</bold> FRQS-APQ <fig><object-id>erj;66/suppl_69/PA1468/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

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Published
2025-09-27
DOI
https://doi.org/10.1183/13993003.congress-2025.pa1468
Primary Topic
Asthma and respiratory diseases
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article
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article

Meta-analysis of exhaled nitric oxide (FeNO) with or without blood eosinophils for asthma diagnosis in adults

Asger Sverrild, Mare Sabbe, Manisha Ramphul, Florence Schleich et al.
Asthma and respiratory diseases
article

Meta-analysis of exhaled nitric oxide (FeNO) with or without blood eosinophils for asthma diagnosis in adults

Asger Sverrild, Mare Sabbe, Manisha Ramphul, Florence Schleich, Javier Mallol, José Luís López-Campos, Jiang-Hua Li, Auxiliadora Romero-Falcón, L Lindhardt Tønnesen, Erol Gaillard, Andréanne Côté, Francine Monique Ducharme, Pip Divall, Simon Couillard, Gilles Louis, Antonius Schneider, Brittany Sanchez, Miguel Salazar, Marc‐André Roy, Vibeke Backer, Morgane Gronnier, Yong He, Samuel Lemaire-Paquette, K. Kowal, Francisco Javier Álvarez Gutiérrez
article en

Abstract

<bold>RATIONALE:</bold> Asthma diagnosis is challenging as spirometry and bronchial provocation tests (BPT) are often non-diagnostic or inaccessible. Type-2 biomarkers identify high-risk, treatment-responsive phenotypes, but their diagnostic value is unclear. <bold>AIM:</bold> Assess FeNO-alone or FeNO plus a blood eosinophil count (FeNO+BEC) for asthma diagnosis. <bold>METHODS:</bold> A systematic review of studies of FENO±BEC for asthma diagnosis based on bronchodilator response and BPT (methacholine-equivalent PC20<8mg⋅ml⁻¹/PD20<200μg = positive) was conducted. Meta-analysis used multiple-threshold (FeNO-alone) and bivariate random effects (FeNO+BEC) models in adults. Receiver operating characteristics’ area under the curve (AUC) and thresholds with positive likelihood ratio (+LR>10) and specificity (>90%) were determined with 95% confidence intervals (CI). PRISMA was followed. <bold>RESULTS:</bold> Of 3957 studies, 17 (n=4520) assessed FeNO, while 5 (n=2689) assessed FeNO+BEC. FeNO showed good diagnostic accuracy (AUC 0.80 [95%CI: 0.75-0.84]); at >46ppb, specificity was 96 [95-98]%, +LR 10.1 [6.29-16.34]. FeNO+BEC modestly increased AUC: 0.84 [0.83-0.86](Figure). <bold>CONCLUSION:</bold> FeNO alone demonstrates good diagnostic accuracy for asthma, with FeNO>46 ppb ruling in the diagnosis. Combining FeNO+BEC did not significantly increase test accuracy. Using FeNO may accelerate and improve diagnostic trajectories. <bold>PROSPERO</bold>#CRD42023489738; <bold>FUNDING:</bold> FRQS-APQ <fig><object-id>erj;66/suppl_69/PA1468/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

Universidad de Santiago de Chile (CL), Université de Sherbrooke (CA), Medical University of Białystok (PL), Army Medical University (CN), University of Liège (BE), Bispebjerg Hospital (DK), Daping Hospital (CN), Hospital La Paz Institute for Health Research (ES), Instituto de Biomedicina de Sevilla (ES), Institut universitaire de cardiologie et de pneumologie de Québec (CA), Directorate General of Health Services (BD), Hospital Universitario Virgen del Rocío (ES), NIHR Leicester Biomedical Research Centre (GB), Université de Montréal (CA)
Openalex Percentile: Top 56%
Asthma and respiratory diseases
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