Objective: Guidelines suggest using bronchial provocation testing (BPT), which is hard to attain, in patients with asthma-like symptoms presenting with nondiagnostic spirometric tests. To eliminate the risk of over/underdiagnosing asthma, we aimed to evaluate the predictive value of not only fractional exhaled nitric oxide (FeNO) but also other easily accessible clinical indices for ruling in/out asthma. Materials and Methods: This retrospective study included adults presenting to our clinic with respiratory symptoms suggestive of asthma but with normal spirometric values and negative reversibility test, who underwent FeNO and methacholine BPT (MchBPT). Medical records were used to obtain descriptive characteristics, clinical history, allergy screening, eosinophils in peripheral blood, and spirometry. Results: Among 51 patients, 19 were diagnosed with asthma. Body mass index and blood eosinophils were significantly higher in patients with positive MchBPT (p=0.042 and p=0.037, respectively). No significant difference was found in other indices, including FeNO (p=0.293). Receiver operating characteristic curve analysis revealed the best diagnostic cutoff level for FeNO as 14 ppb and blood eosinophil as 150/μl for the prediction of positive MchBPT (with 63.16%-62.5% and 80%-61% sensitivity-specificity, respectively). These two indices were the only independent predictors of positive BHR, and the model of FeNO>14ppb combined with eos>150/μl showed 100% specificity with a 100% negative predictive value. Conclusion: Our results suggest using the combination of FeNO with blood eosinophil count as a rule-out test, adding a new step in the algorithmic diagnosis of asthma. This might avoid an unnecessary BPT procedure, reduce the risk of over/under-diagnosis of asthma, and hasten the correct diagnosis.
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Bilun GEMİCİOĞLU ,
Dilşad MUNGAN ,
Sevim BAVBEK ,
Füsun YILDIZ ,
Mehmet POLATLI ,
Sibel NAYCI ,
Ferda Öner ERKEKOL ,
Hatice TÜRKER ,
Hakan GÜNEN ,
Güngör ÇAMSARI ,
Öznur ABADOĞLU ,
Arif ÇIMRIN ,
A. Berna DURSUN ,
Özlem GÖKSEL ,
Seçil Kepil ÖZDEMİR ,
Şermin BÖREKÇİ ,
Ömür AYDIN ,
Birsen OCAKLI ,
Aygün GÜR ,
Arzu BAYGÜL ,
Zeynep MISIRLIGİL
OBJECTIVES: A multicenter trial was designed to validate the “Assessment Tools for Asthma (ATA)” questionnaire, a newly developedquestionnaire, which evaluates both asthma control and risk factors associated with asthma control with a single instrument.MATERIALS AND METHODS: This cross-sectional study involved 810 cases from 14 clinics in 9 Turkish cities. The ATA questionnaire and Asthma Control Test (ACT) were administered. The Visual Analog Scale (VAS) was used to evaluate the control status of 100randomized cases. ATA is an eight-item physician-administered questionnaire. It comprises the following two sections-ATA1, assessessymptomatic control criteria, and the remaining section, queries the flre-up of asthma, control of comorbidities, treatment adherence,and inhaler technique.RESULTS: The mean scores for ATA1, ATA total, VAS, and ACT were 24.7±14.8, 53.8±19, 7.1±3, and 18.8±5.5, respectively. According tothe ATA questionnaire, among all patients, 34.3% had controlled, 18.8% had partly controlled, and 46.9% had uncontrolled asthma. Furthermore, 16.6% patients had flre-ups between visits, 96.4% patients had uncontrolled comorbidity, 17% patients had irregular asthmatreatment, and only 8.4% patients used the incorrect inhaler technique. The ATA questionnaire showed internal consistency (Cronbach’salpha coeffiient=0.683). ACT, ATA1, and two specialists’ evaluations using VAS correlated strongly with the ATA total scores (Spearmancorrelation coeffiient (r) values: 0.776, 0.783, and 0.909, respectively; p-values: p<0.001, p<0.001, and p<0.001, respectively). According to Receiver Operating Characteristic analysis, the cut-off value of ATA was 50 (sensitivity=84.4%, specifiity=82.40%).CONCLUSION: The validated ATA questionnaire may be a practical tool for physicians in asthma management.
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