Influence of the practice setting on diagnostic prediction rules using FENO measurement in combination with clinical signs and symptoms of asthma.
Bottom Line: 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).Ruling out with FENO <16 ppb in patients <43 years was only possible without allergic symptoms when recurrent respiratory tract infections were present.
Affiliation: Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany.Show MeSH
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Mentions: A total of 553 patients participated (320 female (57.9%)). The recruitment rate in general practice was 76%. Nearly every patient from the practices of the pneumologists participated; the data of seven patients could not be used due to incompleteness (figure 1). The diagnosis of asthma was based mainly on bronchial provocation (n=206; 90%); positive bronchodilator response of pre-existing airway obstruction was recorded in only 23 (10%) cases. The prevalence of asthma was highest in the general practice group (table 1). Patients suffered mainly from shortness of breath, wheezing and cough. The patient sample from general practice suffered significantly more from dyspnoea attacks, cough and nasal allergy, and less from dyspnoea on exertion. They used more antiasthmatic medication than patients from the practices of the pneumologists. We found more smokers in the general practice sample, with higher nicotine use. Correspondingly, there were more patients with COPD and ACOS in the general practice sample, accompanied by a significantly lower FEV1, VC and FEV1/VC ratio. Patients with asthma in general practice had significantly more dyspnoea attacks and less dyspnoea on exertion than patients from the practices of pneumologists (p values of subgroups are depicted at the bottom of the table). They also used more antiasthmatic medication. The asthma patients from the general practice showed a significantly lower FEV1/VC ratio compared to the patients with asthma from the pneumologists practices; FEV1 and VC showed no significant difference. Patients in general practice without OAD suffered from cough and recurrent respiratory tract infections significantly more than the patients from the practices of the pneumologists. There were no further significant differences between the patient groups with respect to the other CSS.
Affiliation: Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany.