Assessment of diagnostic accuracy of lung function indices and FeNO for a positive methacholine challenge

[en] Demonstration of bronchial hyperresponsiveness is a key feature in asthma diagnosis. Methacholine challenge has proved to be a highly sensitive test to diagnose asthma in patients with chronic respiratory symptoms and preserved baseline lung function (FEV1 > 70% pred.) but is time consuming and may sometimes reveal unpleasant to the patient. We conducted a retrospective study on 270 patients recruited from the University Asthma Clinic of Liege. We have compared the values of several lung function indices and fractional exhaled nitric oxide (FeNO) in predicting a provocative methacholine concentration ≤16 mg/ml on a discovery cohort of 129 patients (57 already on ICS) and on a validation cohort of 141 patients (66 already on ICS). In the discovery study (n = 129), 85 patients (66%) had a positive methacholine challenge with PC20M ≤ 16 mg/ml. Those patients had lower baseline % predicted FEV1 (92% vs. 100%; p < 0.01), lower FEV1/FVC ratio (79% vs. 82%; p < 0.05), higher RV/TLC ratio (114% vs. 100%; p < 0,0001), lower SGaw (specific conductance) (0.76 vs. 0.95; p < 0,001) and higher FeNO (29 ppb vs. 19 ppb; p < 0,01). When performing ROC curve the RV/TLC ratio provided the greatest AUC (0.74, p < 0.001), sGAW had intermediate AUC of 0.69 (p < 0.001) while FeNO, FEV1 and FEV1/FVC ratio were modestly predictive (AUC of 0.65 (p < 0.05), 0,67 (p < 0.001) and 0,63 (p < 0.001). These results were confirmed in the validation study (n = 141). Based on a logistic regression analysis, significant variables associated with positive methacholine challenge were FeNO and RV/TLC (% Pred). A combined application of FeNO and RV/TLC (% Pred) for predicting the PC20M had a specificity of 85%, a sensitivity of 59% and an AUC of 0.79. In the validation study, three variables (RV/TLC, FeNO and FEV1) were independently associated with positive methacholine challenge and the combination of these three variables yielded a specificity of 77%, a sensitivity of 39% and an AUC of 0.77. The RV/TLC ratio combined to FeNO may be of interest to predict significant methacholine bronchial hyperresponsiveness. © 2020 Elsevier Inc.

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

Bougard, Nicolas ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de cardiologie

Nekoee Zahraei, Halehsadat ; Université de Liège - ULiège > Département des sciences de la santé publique > Biostatistique

SCHLEICH, FLorence ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de pneumologie - allergologie

GUISSARD, Françoise ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Clinique de l'asthme

PAULUS, Virginie ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Clinique de l'asthme

Donneau, Anne-Françoise ; Université de Liège - ULiège > Département des sciences de la santé publique > Biostatistique

Louis, Renaud ; Université de Liège - ULiège > Département des sciences cliniques > Pneumologie - Allergologie

Language :

English

Title :

Assessment of diagnostic accuracy of lung function indices and FeNO for a positive methacholine challenge

Publication date :

2020

Journal title :

Biochemical Pharmacology

ISSN :

0006-2952

eISSN :

1873-2968

Publisher :

Elsevier Inc.

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 17 June 2020

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