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Impulse Oscillometry Combined to FeNO in Relation to Asthma Control Among Preschool Children
Jiying Xiao1, Lingyue Liu1, Kamran Ali2
1Department of Pulmonology, Hangzhou Children's Hospital, Hangzhou, Zhejiang, 310015, People's Republic of China.
Insights
Fractional exhaled nitric oxide (FeNO) and impulse oscillometry (IOS) show significant differences in preschool children with asthma. FeNO is a strong predictor of asthma control, with IOS moderately improving its predictive value when combined.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Allergy and Immunology
Background:
- Asthma control in preschool children remains a clinical challenge, necessitating improved diagnostic and predictive tools.
- Impulse oscillometry (IOS) and fractional exhaled nitric oxide (FeNO) are non-invasive measures of airway function and inflammation, respectively.
- Understanding their role in assessing asthma control in young children is crucial for effective management.
Purpose of the Study:
- To analyze differences in IOS and FeNO metrics between controlled, uncontrolled asthma, and healthy preschool children.
- To evaluate the predictive value of IOS and FeNO, individually and in combination, for identifying uncontrolled asthma in this age group.
Main Methods:
- A cohort of 171 preschool children with asthma and 30 healthy controls were enrolled.
- Asthma control was assessed after a 3-month follow-up, categorizing children into controlled (n=85) and uncontrolled (n=86) groups.
- IOS and FeNO were measured at baseline, and receiver operating characteristic curve (AUROC) analysis was used to determine discriminative ability.
Main Results:
- Significant differences in IOS parameters (R5, X5, R5-R20, Fres) were observed between controlled and uncontrolled asthma groups.
- Fractional exhaled nitric oxide (FeNO) alone demonstrated a high discriminative ability (AUROC=0.88) for uncontrolled asthma.
- Combining IOS metrics with FeNO further enhanced predictive power, with R5-R20+FeNO achieving the highest AUROC of 0.92.
Conclusions:
- Both IOS and FeNO show significant differences related to asthma control in preschool children.
- FeNO emerges as a primary predictor of asthma control, offering substantial discriminative value.
- The integration of IOS metrics with FeNO provides a moderate increase in predictive capability for uncontrolled asthma.
Objective:
We aimed to observe and analyze the differences in impulse oscillometry (IOS) and fractional expiratory nitric oxide (FeNO) in relation to asthma control among preschool children, and to explore the predictive value of IOS combined with FeNO for uncontrolled asthma.
Methods:
This study enrolled 171 preschool children with asthma and 30 healthy preschool children between June 2022 and June 2023. We categorized the asthmatic children as having controlled asthma (n=85) and uncontrolled asthma (n=86) after a 3-month follow-up. IOS and FeNO were collected on the first visit at baseline. Differences in metrics were compared between controlled asthma, uncontrolled asthma and healthy control groups. The area under the receiver operating characteristic curve (AUROC) was utilized to explore the discriminative ability of IOS and FeNO, alone or in combination, against uncontrolled asthma.
Results:
Compared to the controlled asthma group, the IOS values of R5, X5, R5-R20, and Fres were significantly higher in the uncontrolled asthma group, except for R20. R5 and R5-R20 had the highest area under the curve (AUC), which could reach 0.74 (95% CI 0.66-0.82) and 0.72 (95% CI 0.64-0.80). R20 had the lowest AUC of 0.59. The AUC for FeNO alone was 0.88 (95% CI 0.84-0.93) with a cutoff value of 17.50 ppb, sensitivity and specificity of 0.73 and 0.89. The AUCs of all IOS metrics combined with FeNO were significantly higher, with the highest AUC of 0.92 (95% CI 0.87-0.96) for R5-R20+FeNO, and with a sensitivity and specificity of 0.88 and 0.84.
Conclusion:
There were significant differences in IOS and FeNO in relation to asthma control among preschooler children. FeNO might be the best predictor of asthma control, and adding any of IOS metrics increased moderately the predictive value.
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