Fractional exhaled nitric oxide in the assessment of exercise‐induced bronchoconstriction: a multicenter retrospective analysis of UK‐based athletes

Dickinson, J, Gowers, W, Sturridge, S, Williams, N ORCID: https://orcid.org/0000-0002-2607-4572, Kippelen, P, Simpson, A, Jackson, A, Hull, JH and Price, OJ, 2023. Fractional exhaled nitric oxide in the assessment of exercise‐induced bronchoconstriction: a multicenter retrospective analysis of UK‐based athletes. Scandinavian Journal of Medicine and Science in Sports. ISSN 0905-7188

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Abstract

Introduction: Exercise-induced bronchoconstriction (EIB) is not only highly prevalent in people with asthma, but can also occur independently, particularly in athletes. Fractional exhaled nitric oxide (FeNO) is an indirect biomarker of type 2 airway inflammation that has an established role in the assessment and management of asthma. The aim was to evaluate the value of FeNO in the assessment of EIB in athletes.

Method: Multicenter retrospective analysis. In total, 488 athletes (male: 76%) performed baseline FeNO, and spirometry pre- and post-indirect bronchial provocation via eucapnic voluntary hyperpnea (EVH). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for established FeNO thresholds—that is, intermediate (≥25 ppb) and high FeNO (≥40 ppb and ≥ 50 ppb)—and were evaluated against objective evidence of EIB (≥10% fall in FEV1). The diagnostic accuracy of FeNO was calculated using receiver operating characteristics area under the curve (ROC-AUC).

Results: Thirty-nine percent of the athletes had a post-EVH fall in FEV1 consistent with EIB. FeNO values ≥25 ppb, ≥40 ppb, and ≥ 50 ppb were observed in 42%, 23%, and 17% of the cohort, respectively. The sensitivity of FeNO ≥25 ppb was 55%, which decreased to 37% and 27% at ≥40 ppb and ≥ 50 ppb, respectively. The specificity of FeNO ≥25 ppb, ≥40 ppb, and ≥ 50 ppb was 66%, 86%, and 89%, respectively. The ROC-AUC for FeNO was 0.656.

Conclusions: FeNO ≥40 ppb provides good specificity, that is, the ability to rule-in a diagnosis of EIB. However, due to the poor sensitivity and predictive values, FeNO should not be employed as a replacement for indirect bronchial provocation in athletes.

Item Type:	Journal article
Publication Title:	Scandinavian Journal of Medicine and Science in Sports
Creators:	Dickinson, J., Gowers, W., Sturridge, S., Williams, N., Kippelen, P., Simpson, A., Jackson, A., Hull, J.H. and Price, O.J.
Publisher:	Wiley
Date:	13 April 2023
ISSN:	0905-7188
Identifiers:	Number Type 10.1111/sms.14367 DOI 1757260 Other
Rights:	© 2023 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Divisions:	Schools > School of Science and Technology
Record created by:	Linda Sullivan
Date Added:	12 May 2023 08:18
Last Modified:	12 May 2023 08:18
URI:	https://irep.ntu.ac.uk/id/eprint/48942

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