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| Application value of fractional exhaled nitric oxide in etiological diagnosis of chronic cough in children |
| ZHANG Yu SHEN Yongwang TIAN Junping |
Ward One, Department of General Pediatrics, Dingzhou People’s Hospital, Hebei Province, Dingzhou 073000，China
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Abstract Objective To explore the application value of fractional exhaled nitric oxide (FeNO) in etiological diagnosis of chronic cough in children. Methods A total of 200 children with chronic cough treated in Dingzhou People’s Hospital of Hebei Province from July 2020 to July 2021 were selected as the study objects. The etiological of chronic cough was analyzed; FeNO, lung function, and eosinophilic granulocyte count in induced sputum were compared; the diagnostic value of FeNO in children with chronic cough of different etiology was analyzed. Results Among 200 children with chronic cough, 198 cases were identified and 2 cases were unknown. There were 172 cases of single cause and 21 cases of double cause, 5 cases of other reasons. The top five etiologies of chronic cough in children were upper airway cough syndrome (UACS), cough variant asthma (CVA), postinfectious cough (PIC), eosinophilic bronchitis (EB), and CVA+UACS. There were statistically significant differences in FeNO, the cumulative amount of provocative medication required to reduce forced expiratory volume in one second by 20%, and the percentage of eosinophils in induced sputum among children with different etiologies (P＜0.05); there were no significant differences in forced expiratory volume in one second and forced expiratory volume in one second/forced vital capacity of children with different etiologies (P＞0.05). The area under the curve (AUC) value of FeNO diagnosis PIC was 0.765 [95%CI (0.651-0.878)], the optimal cut-off value was 19.0 ppb, the sensitivity was 80.0%, the specificity was 63.8%, and the Yoden index was 0.44. The AUC value for FeNO diagnosis of UACS was 0.835[95%CI(0.760-0.909)], the optimal cut-off value was 15.5 ppb, the sensitivity was 82.0%, the specificity was 73.2%, and the Yoden index was 0.55. The AUC value for FeNO diagnosis of CVA was 0.947[95%CI (0.898-0.996)], the optimal cut-off value was 24.5 ppb, the sensitivity was 86.0%, the specificity was 88.0%, and the Yoden index was 0.74. The AUC value of FeNO diagnosis of EB was 0.814[95%CI (0.693-0.935)], the optimal cut-off value was 19.5 ppb, the sensitivity was 81.0%, the specificity was 83.0%, and the Yoden index was 0.64. The AUC value for FeNO diagnosis of CVA+UACS was 0.916[95%CI (0.817-1.000)], the optimal cut-off value was 18.5 ppb, the sensitivity was 80.0%, the specificity was 73.3%, and the Yoden index was 0.53. Conclusion FeNO, as a marker of airway inflammation, can be used as a method to evaluate airway inflammation, and it can be used to identify eosinophile-associated airway inflammatory diseases from other causes of chronic cough. FeNO can be used as an important diagnostic basis for chronic cough in children.
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