Introdução à Medicina 2006/2007 Class 3, First Year João Almeida Lopes Fonseca

11

The Use of Exhaled Nitric Oxide The Use of Exhaled Nitric Oxide and Induced Sputum Eosinophilia and Induced Sputum Eosinophilia

in the Diagnosis of Asthmain the Diagnosis of Asthma

– a systematic review– a systematic review – –

Introdução à Medicina 2006/2007

Class 3, First YearJoão Almeida Lopes Fonseca Altamiro Manuel Rodrigues da Costa Pereira

The Use of Exhaled Nitric Oxide and Induced Sputum Eosinophilia in the Diagnosis of Asthma


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SummarySummary Introduction

• Current Tests• Inflammatory Biomarkers• Aim

Methods • Study Design• Data source• Study Selection• Quality Criteria• Statistical Analysis

Flow Chart

Results

Gantt chart



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IntroductionIntroduction Asthma is an inflammatory disorder

Asthma diagnosis:

• Mostly based on the clinical observation complemented with lung function tests

• Bronchodilatation and hiperreactivity tests (methacholine)

• There is growing interest in exhaled nitric oxide (Fe(NO)) and induced sputum eosinophilia



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Introduction Introduction Current Tests

GINA. 2006 Nov

Dundas I. Thorax. 2005 Jan

Busse WW. Am J Respir Crit Care Med. 2005 Oct

Lung function

Bronchodilatation Methacholine Bronchial

Biopsy

Safe

Non-Invasive Quick and

Easy

Sensitive

Specific

Tests

Parameters



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Introduction Introduction Inflammatory Biomarkers

Lemiere C et al. Can J Physiol Pharmacol. 2006 Jan Joos GF et al. Curr Opin Pharmacol. 2003 Jun

Dinakar C et al. Curr Allergy Asthma Rep. 2004 Nov

Kim CK et al. Ann Allergy Asthma Immunol. 2004 Aug

Fe(NO)Induced Sputum

Eosinophilia

Safe

Non-Invasive

Quick and Easy

Sensitive ? ?

Specific ? ?

Tests

Parameters



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Introduction Introduction Aim

To evaluate the sensitivity and the

specificity of Fe(NO) and

induced sputum eosinophilia

in asthma diagnosis



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Methods Methods Study Design

A meta-analysis of the published

studies on the sensitivity and

specificity of measurements of

Fe(NO) and induced sputum

eosinophilia



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Methods Methods Data sourceResearch was made using Medline, Scopus and references of

used articles.• Query of Medline was:

(("Asthma"[MeSH] OR Asthma OR Asthm*) AND (("Nitric Oxide"[MeSH] OR feno OR ENO OR exhaled

air) OR ((Eosinophil[MeSH] OR Eosinophil* OR Eosinophilia[MeSH])AND

(Sputum[MeSH] OR Sputum))) AND ((sensitiv*[Title/Abstract] OR sensitivity and

specificity[MeSH Terms] OR diagnos*[Title/Abstract] OR diagnosis[MeSH:noexp]

OR diagnostic * [MeSH:noexp] OR diagnosis,differential[MeSH:noexp] OR

diagnosis[Subheading:noexp] OR (Diagnosis[MeSH] OR Diagnosis OR Diagnos*))



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Methods Methods Data source

• Query of Scopus was:

(((asthma OR asthm) AND ((nitric oxide OR feno OR eno OR exhaled air) OR (eosinophil

OR eosinophilia) AND sputum)) AND

(((sensitiv OR sensitivity) AND specificity) OR (diagnostic OR differential diagnosis OR

diagnosis)))AND PUBYEAR AFT 1991



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Methods Methods Study Selection

• Six groups of two reviewers - titles/abstracts• Six groups of two reviewers - full text

• Articles atributted randomly using excel

• Checked inclusion and exclusion criteria to select the articles

1st stage: titles/abstracts 2nd stage: full text.



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• Non-agreement on 1st stage: The article is included

• Non-agreement on 2nd stage solved by: Consensus

or A third reviewer (a specialist in the field).



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Inclusion criteria

1. Studies the use of exhaled nitric oxide or eosinophil levels in induced sputum for the diagnosis of asthma in humans.

2. Reports original data on the sensitivity and specificity of the application of inflammatory biomarkers

Exclusion criteria

3. Not written in English, Portuguese, French or Spanish.4. Full text not available via Medline, Scopus or FMUP library.5. Does not describe the criteria use for the diagnosis of

asthma



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Methods Methods Quality Criteria

The articles included were evaluated regarding their methodological quality using a scale based on

STARD.

1. http://www.consort-statement.org/stardstatement.htm



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Methods Methods Statistical Analysis

• Meta-Disc 1.4 and SPSS 14.0 - Relevant information extracted from the chosen articles was registered.

• Main parameters - SensitivitySensitivity and SpecifitySpecifity of inflammatory biomarkers:

Nitric oxide Eosinophils

• Kappa Statistics - compares the agreement against that which might be expected by chance.



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Flow chartFlow chart



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ResultsResultsProportion of Inclusion/Exclusion – Pubmed and Scopus



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ResultsResultsDegree of Concordance-Titles/Abstracts and Full Texts



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ResultsResultsExclusion Criteria – Titles/Abstracts and Full Texts



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Data extractionData extraction



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Data extractionData extraction



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Quality AssessmentQuality Assessment

The first three articles with the better quality evaluation:

• Pijnenburg, MW - Thorax – 2005 – 23,5 pts

• Hefflera, E - Respiratory Medicine – 2006 – 19,5 pts

• Efthimiadis, A - The Journal of Allergy and Clinical Immunology – 2000 – 18,5 pts

Highest pontuation – 23,5 points



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Site MapSite Map

HOME

Abstract

Full ArticleHTML

Appendix

Authors

Presentations

PP1

st

2nd

3rd

Gantt chart

Flow chart

Site MapRelated Sites

Introduction

Methods

Results

Discussion

Full ArticlePDF



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Gantt chartGantt chart

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Introdução à Medicina 2006/2007 Class 3, First Year João Almeida Lopes Fonseca