Does FeNO Predict Clinical Characteristics in Chronic Cough?

Mahboobeh Haji Sadeghi, Caroline E Wright, Simon Hart, Michael Crooks, Alyn H Morice, Mahboobeh Haji Sadeghi, Caroline E Wright, Simon Hart, Michael Crooks, Alyn H Morice

Abstract

Purpose: To evaluate whether exhaled nitric oxide measurement can facilitate in the assessment of chronic cough patients based on their airway inflammatory phenotype.

Methods: We have studied consecutive patients attending a specialist cough clinic. 30 patients with high FeNO (> 30 ppb) and 20 patients with low FeNO (< 20 ppb) were recruited.

Results: There was a significant correlation between FeNO, B-Eos and sputum eosinophil count (p < 0.001). The number of recorded coughs in 24 h and HARQ scores were significantly (p < 0.05) higher in patients with a low FeNO. In contrast to the high FeNO group (48%), the greater proportion of these patients were women (90%). LCQ scores were worse in the low FeNO group but it was not significant.

Conclusion: A strong relationship between FeNO, blood eosinophils and sputum eosinophils confirming phenotypic identity was observed. Whether the observed gender disparity accounts for the different cough frequency characteristics is unknown.

Keywords: Airway inflammation; Chronic cough; FeNO.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Scatter plot of FeNO ppb and B-Eos × 109/L. Filled triangle: Low FeNO group. Circle: High FeNO group
Fig. 2
Fig. 2
Bland–Altman plot of current B-Eos and previous B-Eos. Filled triangle: Low FeNO group. Circle: High FeNO group
Fig. 3
Fig. 3
Scatter plot of FeNO ppb and sputum Eos%. Filled triangle: Low FeNO group. Circle: High FeNO group

References

    1. Chatkin JM, et al. Exhaled nitric oxide as a noninvasive assessment of chronic cough. 1999;159(6):1810–1813.
    1. Fujimura M, et al. Exhaled nitric oxide levels in patients with atopic cough and cough variant asthma. Respirology. 2008;13(3):359–364. doi: 10.1111/j.1440-1843.2008.01273.x.
    1. Oh M-J, et al. Exhaled nitric oxide measurement is useful for the exclusion of nonasthmatic eosinophilic bronchitis in patients with chronic cough. Chest. 2008;134(5):990–995. doi: 10.1378/chest.07-2541.
    1. Maniscalco M, et al. Extended analysis of exhaled and nasal nitric oxide for the evaluation of chronic cough. Respir Med. 2015;109(8):970–974. doi: 10.1016/j.rmed.2015.05.016.
    1. Yi F, et al. Validity of fractional exhaled nitric oxide in diagnosis of corticosteroid-responsive cough. Chest. 2016;149(4):1042–1051. doi: 10.1016/j.chest.2016.01.006.
    1. ATS/ERS Recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med. 2005;171(8):91230.
    1. Dweik RA, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med. 2011;184(5):602–615. doi: 10.1164/rccm.9120-11ST.
    1. Miller MR, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319338. doi: 10.1183/09031936.05.00034805.
    1. Barry SJ, et al. The automatic recognition and counting of cough. Cough. 2006;2:8. doi: 10.1186/1745-9974-2-8.
    1. Birring SS, et al. The Leicester Cough Monitor: preliminary validation of an automated cough detection system in chronic cough. Eur Respir J. 2008;31(5):1013–1018. doi: 10.1183/09031936.00057407.
    1. Faruqi S, et al. Quantifying chronic cough: objective versus subjective measurements. Respirology. 2011;16(2):314–320. doi: 10.1111/j.1440-1843.2010.01893.x.
    1. Boot JD, Panzner P, Diamant Z. A critical appraisal of methods used in early clinical development of novel drugs for the treatment of asthma. Pulm Pharmacol Ther. 2007;20(3):201–219. doi: 10.1016/j.pupt.2006.02.001.
    1. Birring S, et al. Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ) Thorax. 2003;58(4):339–343. doi: 10.1136/thorax.58.4.339.
    1. McGarvey L, Morice AH. Atopic cough: little evidence to support a new clinical entity. Thorax. 2003;58(8):736–737. doi: 10.1136/thorax.58.8.736-a.
    1. Irwin R, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006;129:1S–23S. doi: 10.1378/chest.129.1_suppl.1S.
    1. Morice AH, et al. A worldwide survey of chronic cough: a manifestation of enhanced somatosensory response. Eur Respir J. 2014;44(5):1149–1155. doi: 10.1183/09031936.00217813.
    1. Kastelik JA, et al. Sex-related differences in cough reflex sensitivity in patients with chronic cough. Am J Respir Crit Care Med. 2002;166(7):961–964. doi: 10.1164/rccm.2109061.
    1. Price DB, et al. Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study. Lancet Respir Med. 2015;3(11):849–858. doi: 10.1016/S2213-2600(15)00367-7.
    1. Kelsall A, et al. Sex differences and predictors of objective cough frequency in chronic cough. Thorax. 2009;64(5):393–398. doi: 10.1136/thx.2008.106237.
    1. Strunk RC, et al. Relationship of exhaled nitric oxide to clinical and inflammatory markers of persistent asthma in children. J Allergy Clin Immunol. 2003;112(5):883–892. doi: 10.1016/j.jaci.2003.08.014.
    1. Malinovschi A, et al. Exhaled nitric oxide levels and blood eosinophil counts independently associate with wheeze and asthma events in National Health and Nutrition Examination Survey subjects. J Allergy Clin Immunol. 2013;132(4):821–827. doi: 10.1016/j.jaci.2013.06.007.
    1. Wagener AH, et al. External validation of blood eosinophils, FE(NO) and serum periostin as surrogates for sputum eosinophils in asthma. Thorax. 2015;70(2):115–120. doi: 10.1136/thoraxjnl-2014-205634.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir