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Contribution of Exhaled Nitric Oxide Measurements to Abbreviated Bronchial Challenge Test Protocols
Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain E-mail: amparolloris@yaho
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Lloris Bayo Servicio de Neumología, Hospital Universitario La Fe Avda. Campanar, 21 46009 Valencia, Spain" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec155338" "palabras" => array:4 [ 0 => "Exhaled nitric oxide" 1 => "Bronchial challenge test" 2 => "Receiver operating characteristic (ROC) curves" 3 => "Exaggerated bronchoconstriction" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec155337" "palabras" => array:4 [ 0 => "Óxido nítrico exhalado" 1 => "Prueba de provocación bronquial" 2 => "Curvas de eficacia diagnóstica" 3 => "Broncoconstricción excesiva" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The bronchial challenge test is commonly used to diagnose asthma but it is a tedious, time-consuming procedure. Although in recent years, several shortened methods have been proposed, it has been shown that they can give rise to exaggerated bronchoconstriction. The aims of the present study were <span class="elsevierStyleItalic">a)</span> to determine the frequency of exaggerated bronchoconstriction in patients with asthma following the application of a shortened bronchial challenge test, and <span class="elsevierStyleItalic">b)</span> to determine if the fraction of exhaled nitric oxide (FE<span class="elsevierStyleInf">NO</span>) can be used to predict the onset of exaggerated bronchoconstriction.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We performed a prospective study of 210 patients with asthma in whom FE<span class="elsevierStyleInf">NO</span> levels were measured in accordance with the abbreviated protocol recommended by the European Respiratory Society (ERS). Exaggerated bronchoconstriction was defined as a decrease of more than 20% in forced expiratory volume in 1 second after the first challenge, after a skipped dose, or after administration of saline. A receiver operating characteristic (ROC) curve was generated to determine the best FE<span class="elsevierStyleInf">NO</span> cutoff value for predicting exaggerated bronchoconstriction. The pretest probability of developing exaggerated bronchoconstriction was also calculated using Bayes' theorem.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The frequency of exaggerated bronchoconstriction in our series was 30%. Patients who developed exaggerated bronchoconstriction had significantly higher FE<span class="elsevierStyleInf">NO</span> levels than those who did not (32.6 vs 16.2 parts per billion [ppb]). The chosen FE<span class="elsevierStyleInf">NO</span> cutoff of 19.5 ppb had a sensitivity of 80%, a specificity of 77%, and a negative predictive value of 88%. The area under the ROC curve was 0.83 (95% confidence interval, 0.77–0.89).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The abbreviated bronchial challenge test recommended by the ERS led to exaggerated bronchoconstriction in 30% of the patients studied. FE<span class="elsevierStyleInf">NO</span> measurements could possibly be used to identify patients at increased risk of exaggerated bronchoconstriction. The shortened challenge test can be performed safely in individuals with a FE<span class="elsevierStyleInf">NO</span> of <19.5 ppb.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">La prueba de provocación bronquial es un procedimiento habitual en el diagnóstico del asma, pero su realización resulta larga y tediosa. Por ello se han propuesto métodos que acortan su duración. Sin embargo, en los últimos años se ha señalado que dichos métodos pueden dar lugar a broncoconstricciones excesivas (BE). Los objetivos del presente estudio han sido: a) determinar la frecuencia de BE en pacientes con asma tras la aplicación del método abreviado de la prueba de provocación bronquial, y b) cuantificar si la determinación de óxido nítrico en aire exhalado (ONE) puede predecir la aparición de BE.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio prospectivo sobre 210 asmáticos a quienes se determinó el ONE y se realizó una prueba de provocación bronquial siguiendo el protocolo abreviado de la European Respiratory Society (ERS). Se definió BE como una caída superior al 20% del volumen espiratorio forzado en el primer segundo tras la primera dosis, después de suprimir una dosis o tras el diluyente. Se construyó una curva de eficacia diagnóstica para determinar el mejor punto de corte del ONE para predecir BE y se calculó la probabilidad preprueba de presentar BE, siguiendo el teorema de Bayes.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La frecuencia de BE en nuestra serie fue del 30%. Hubo diferencias significativas en el ONE, siendo la concentración más elevada en el grupo que presentó BE (32,6 frente a 16,2 ppb). El punto de corte de ONE elegido fue 19,5 ppb, con una sensibilidad del 80%, especificidad del 77% y valor predictivo negativo del 88%. El área bajo la curva de eficacia diagnóstica fue de 0,83 (intervalo de confianza del 95%, 0,77–0,89).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La prueba de provocación bronquial abreviada que recomienda la ERS da lugar a un 30% de BE. La determinación de ONE podría identificar a los pacientes con mayor probabilidad de presentar BE. Una concentración de ONE inferior a 19,5 ppb permite realizar la prueba de provocación bronquial abreviada con seguridad.</p>" ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara">This study was partly funded by a grant from the Instituto de Salud Carlos III (PI05/0583).</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Standardization of bronchial inhalation challenge procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H Chai" 1 => "RS Farr" 2 => "LA Froeligh" 3 => "DA Mathison" 4 => "JA McLean" 5 => "RR Rosenthal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "1975" "volumen" => "56" "paginaInicial" => "323" "paginaFinal" => "327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1176724" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bronchial reactivity to inhaled histamine: a method and clinical survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "DW Cockcroft" 1 => "DN Killian" 2 => "JJA Mellon" 3 => "FE Hargreave" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Allergy" "fecha" => "1977" "volumen" => "7" "paginaInicial" => "235" "paginaFinal" => "243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/908121" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Airway responsiveness: standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 1 | 2 |
| 2024 October | 31 | 19 | 50 |
| 2024 September | 29 | 12 | 41 |
| 2024 August | 38 | 26 | 64 |
| 2024 July | 24 | 22 | 46 |
| 2024 June | 34 | 19 | 53 |
| 2024 May | 27 | 30 | 57 |
| 2024 April | 21 | 22 | 43 |
| 2024 March | 20 | 20 | 40 |
| 2024 February | 15 | 27 | 42 |
| 2023 March | 4 | 3 | 7 |
| 2023 February | 15 | 24 | 39 |
| 2023 January | 20 | 27 | 47 |
| 2022 December | 19 | 21 | 40 |
| 2022 November | 17 | 27 | 44 |
| 2022 October | 20 | 30 | 50 |
| 2022 September | 21 | 14 | 35 |
| 2022 August | 19 | 38 | 57 |
| 2022 July | 23 | 45 | 68 |
| 2022 June | 22 | 37 | 59 |
| 2022 May | 16 | 27 | 43 |
| 2022 April | 23 | 30 | 53 |
| 2022 March | 23 | 41 | 64 |
| 2022 February | 16 | 36 | 52 |
| 2022 January | 15 | 32 | 47 |
| 2021 December | 18 | 44 | 62 |
| 2021 November | 14 | 56 | 70 |
| 2021 October | 17 | 58 | 75 |
| 2021 September | 12 | 61 | 73 |
| 2021 August | 14 | 35 | 49 |
| 2021 July | 12 | 34 | 46 |
| 2021 June | 10 | 33 | 43 |
| 2021 May | 13 | 29 | 42 |
| 2021 April | 39 | 104 | 143 |
| 2021 March | 14 | 22 | 36 |
| 2021 February | 14 | 23 | 37 |
| 2021 January | 8 | 19 | 27 |
| 2020 December | 13 | 15 | 28 |
| 2020 November | 11 | 19 | 30 |
| 2020 October | 12 | 14 | 26 |
| 2020 September | 6 | 5 | 11 |
| 2020 August | 12 | 9 | 21 |
| 2020 July | 17 | 19 | 36 |
| 2020 June | 5 | 3 | 8 |
| 2020 May | 12 | 10 | 22 |
| 2020 April | 17 | 22 | 39 |
| 2020 March | 15 | 12 | 27 |
| 2020 February | 17 | 11 | 28 |
| 2020 January | 12 | 12 | 24 |
| 2019 December | 11 | 16 | 27 |
| 2019 November | 16 | 14 | 30 |
| 2019 October | 10 | 10 | 20 |
| 2019 September | 9 | 13 | 22 |
| 2019 August | 39 | 11 | 50 |
| 2019 July | 14 | 16 | 30 |
| 2019 June | 9 | 7 | 16 |
| 2019 May | 14 | 6 | 20 |
| 2019 April | 38 | 11 | 49 |
| 2019 March | 24 | 12 | 36 |
| 2019 February | 11 | 14 | 25 |
| 2019 January | 12 | 9 | 21 |
| 2018 December | 13 | 9 | 22 |
| 2018 November | 20 | 18 | 38 |
| 2018 October | 25 | 24 | 49 |
| 2018 September | 14 | 6 | 20 |
| 2018 May | 9 | 0 | 9 |
| 2018 April | 12 | 5 | 17 |
| 2018 March | 11 | 4 | 15 |
| 2018 February | 7 | 4 | 11 |
| 2018 January | 11 | 8 | 19 |
| 2017 December | 8 | 6 | 14 |
| 2017 November | 2 | 0 | 2 |
| 2017 October | 8 | 7 | 15 |
| 2017 September | 3 | 9 | 12 |
| 2017 August | 4 | 14 | 18 |
| 2017 July | 14 | 19 | 33 |
| 2017 June | 6 | 14 | 20 |
| 2017 May | 6 | 9 | 15 |
| 2017 April | 2 | 5 | 7 |
| 2017 March | 7 | 13 | 20 |
| 2017 February | 6 | 6 | 12 |
| 2017 January | 3 | 1 | 4 |
| 2016 December | 10 | 8 | 18 |
| 2016 November | 9 | 4 | 13 |
| 2016 October | 19 | 14 | 33 |
| 2016 September | 11 | 9 | 20 |
| 2016 August | 11 | 4 | 15 |
| 2016 July | 5 | 3 | 8 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2016 January | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 28 | 13 | 41 |
| 2015 September | 34 | 10 | 44 |
| 2015 August | 32 | 12 | 44 |
| 2015 July | 33 | 4 | 37 |
| 2015 June | 22 | 11 | 33 |
| 2015 May | 42 | 16 | 58 |
| 2015 April | 33 | 8 | 41 |
| 2015 March | 29 | 6 | 35 |
| 2015 February | 32 | 9 | 41 |
| 2015 January | 43 | 7 | 50 |
| 2014 December | 27 | 4 | 31 |
| 2014 November | 37 | 6 | 43 |
| 2014 October | 38 | 9 | 47 |
| 2014 September | 26 | 7 | 33 |
| 2014 August | 31 | 9 | 40 |
| 2014 July | 30 | 8 | 38 |
| 2014 June | 43 | 9 | 52 |
| 2014 May | 43 | 12 | 55 |
| 2014 April | 53 | 6 | 59 |
| 2014 March | 54 | 6 | 60 |
| 2014 February | 46 | 15 | 61 |
| 2014 January | 37 | 7 | 44 |
| 2013 December | 37 | 10 | 47 |
| 2013 November | 37 | 7 | 44 |
| 2013 October | 44 | 8 | 52 |
| 2013 September | 33 | 10 | 43 |
| 2013 August | 51 | 7 | 58 |
| 2013 July | 51 | 10 | 61 |
| 2013 June | 39 | 12 | 51 |
| 2013 May | 40 | 8 | 48 |
| 2013 April | 25 | 6 | 31 |
| 2013 March | 8 | 2 | 10 |
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