diagnostic accuracy of exhaled nitric oxide in exercise-induced bronchospasm: systematic review

Clicks: 158
ID: 210524
2012
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Abstract
Introduction: The gold-standard method for the diagnosis of exercise-induced bronchospasm (EIB) is an exercise test combined with spirometry. However, this test is expensive, time consuming and requires specialized equipment and trained personnel. Exhaled nitric oxide (eNO) is a fast, easy, noninvasive method for the diagnosis of EIB. The aim of the present study was to assess the accuracy of the measurement of eNO for the diagnosis of EIB through a systematic review of the literature. Methods: A search was carried out in the PubMed, Lilacs, SciELO and SCOPUS databases by two independent researchers. Results: Fifty-six papers were found. Following the application of the eligibility criteria to the title, abstract and text, six papers remained for analysis. There was a significant heterogeneity in sex (X2 = 56.44, p = 0.000) and clinical spectrum (X2 = 504.00, p = 0.000) between studies. In children between 3.8 and 7.8 years old a cutoff point >28 ppb EIB can be ruled in and in children between 5 and 16 years old at a cutoff point <20 EIB can be ruled out. For adults a cutoff point <7 EIB can be ruled out and it can be ruled in with a cutoff point >12. Four papers reported negative predictive values above 88%. Conclusion: The measurement of eNO seems to be effective for ruling in and ruling out EIB in some specific groups. Therefore, the meansurement of eNO levels could be an important tool to safely avoid the need for an exercise test when the result is negative, reducing the individual and economic impact of this disease. Resumo: Introdução: O método padrão de ouro para o diagnóstico de broncoespasmos induzidos por exercício (BIE) é a prova de esforço combinada com a espirometria. Contudo, esta prova é dispendiosa, demorada e requer equipamento específico e pessoal especializado. O óxido nítrico exalado (eNO) é um método rápido, simples e não invasivo para o diagnóstico de BIE. O objectivo do presente estudo foi o de aferir a acurácia do eNO para o diagnóstico do BIE através da revisão sistemática da literatura. Métodos: Foi efectuada uma pesquisa nas bases de dados PubMed, Lilacs, SciELO e SCOPUS por dois investigadores independentes. Resultados: Foram encontrados 56 artigos e após as exclusões pelo título, resumo e texto, restaram 6 artigos para análise. Foi encontrada heterogeneidade significativa entre os estudos quanto ao sexo (X2=56,44; p=0,000) e ao espectro clínico (X2 =504,00; p=0,000). Em crianças com idades entre os 3,8 e os 7,8 anos o ponto de corte >28 ppb pode considerar o BIE presente, e em crianças com idades entre os 5 e os 16 anos o ponto de corte <20 BIE poderá excluir essa afecção. Para adultos o BIE poderá ser excluído quando o ponto de corte for <7 BIE e o ponto de corte >12 poderá considerar a presença da doença. Quatro artigos registaram valores preditores negativos acima dos 88%. Conclusão: A avaliação do eNO parece ser eficaz na inclusão ou na exclusão de BIE em alguns grupos específicos. Assim sendo, a avaliação dos níveis de eNO poderá ser uma ferramenta segura para evitar a necessidade da prova de esforço nos casos negativos, reduzindo a impacto individual e económico desta doença. Keywords: Exercise-induced asthma, Diagnosis, Sensitivity and specificity, Nitric oxide, Palavras-chave: Asma induzida por exercício, diagnóstico, sensibilidade e especificidade, óxido nítrico
Reference Key
feitosa2012revistadiagnostic Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;L.A.S. Feitosa;A. Dornelas de Andrade;C.M.A. Reinaux;M.C.A. Britto
Journal the journal of applied psychology
Year 2012
DOI
DOI not found
URL
http://www.sciencedirect.com/science/article/pii/S0873215912000335
Keywords
diseases of the respiratory system

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