ArticleBMJ open2015
Influence of the practice setting on diagnostic prediction rules using FENO measurement in combination with clinical signs and symptoms of asthma.
Article in BMJ open, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 3 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 3 syntheses or guidelines pooled it, 26 citations in OpenAlex.
- Methodological and applicability pitfalls of clinical prediction models for asthma diagnosis: a systematic review and critical appraisal of evidence.BMC medical research methodology · 2025Pooled it
- Fractional Exhaled Nitric Oxide Testing for the Diagnosis and Management of Asthma: a Health Technology Assessment.Ontario health technology assessment series · 2024Pooled it
- Systematic review of clinical prediction models to support the diagnosis of asthma in primary care.NPJ primary care respiratory medicine · 2019Pooled it
- Development and validation of a nomogram for predicting cough variant asthma diagnosis.BMC pulmonary medicine · 2025Article
- Deriving and validating an asthma diagnosis prediction model for children and young people in primary care.Wellcome open research · 2023Article
- Diagnostic accuracy of FeNO in asthma and predictive value for inhaled corticosteroid responsiveness: A prospective, multicentre study.EClinicalMedicine · 2022Article
- A dynamic nomogram for predicting the risk of asthma: Development and validation in a database study.Journal of clinical laboratory analysis · 2021Article
- Fractional exhaled nitric oxide as a determinant for the clinical course of asthma: a systematic review.European clinical respiratory journal · 2021Review
- Article
- The use of a direct bronchial challenge test in primary care to diagnose asthma.NPJ primary care respiratory medicine · 2020Observational
- [Clinical significance of fractional exhaled nitric oxide combined with in vitro allergen test in identifying children at a high risk of asthma among those with recurrent wheezing].Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2017Article
- Use of electronic medical records and biomarkers to manage risk and resource efficiencies.European clinical respiratory journal · 2017Article
- Clinical Utility of Fractional exhaled Nitric Oxide (FeNO) as a Biomarker to Predict Severity of Disease and Response to Inhaled Corticosteroid (ICS) in Asthma Patients.Journal of clinical and diagnostic research : JCDR · 2016Article
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo evaluate the influence of the practice setting on diagnostic accuracy of fractional exhaled nitric oxide (FENO) for diagnosing asthma; and to develop prediction rules for diagnostic decision-making including clinical signs and symptoms (CSS).
settingPatients from 10 general practices and 1 private practice of 5 pneumologists in ambulatory care.
participants553 patients, 57.9% female. Consecutive inclusion of diagnostic-naive patients suspected of suffering from obstructive airway disease. Exclusion criteria were respiratory tract infections within the last 6 weeks.
interventionsThe index test was FENO measurement. Reference standard was the Tiffeneau ratio (forced expiratory volume in 1 s/vital capacity) or airway resistance as assessed by whole body plethysmography, with additional bronchoprovocation or bronchodilator testing. PRIMARY AND SECONDARY OUTCOME MEASURES: Asthma as determined by pneumologists, who were blind to FENO measurement results. Prediction rules were derived from multiple logistic regression analysis. A freely available calculator that allows computing all combinations was developed.
resultsThe practice setting only had minor influence on sensitivities of FENO cut-off points. In the final model (n=472), allergic rhinitis, wheezing and previous medication were positively associated with asthma. Increasing age and recurrent respiratory tract infections were negatively associated. The area under the curve (AUC) of FENO (AUC=0.650; 95% CI 0.599 to 0.701) increased significantly (p<0.0001) when combined with CSS (AUC=0.753; 95% CI 0.707 to 0.798). Presence of wheezing and allergic rhinitis allowed ruling in asthma with FENO >30 ppb. Ruling out with FENO <16 ppb in patients <43 years was only possible without allergic symptoms when recurrent respiratory tract infections were present.
conclusionsFENO results should be interpreted in the context of CSS to enhance their diagnostic value in primary care. The final diagnostic model appears as a sound algorithm fitting well to the established diagnostic rules related to CSS of asthma. FENO appears more effective for ruling in asthma than for ruling it out.
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