Background: Sputum eosinophil and fractional exhaled nitric oxide (FeNO), noninvasive biomarkers of local eosinophilic airway inflammation, can be used to assess asthma outcome. Nevertheless, the clinical application of the association between FeNO and sputum eosinophil is controversial. The aim of the study was to investigate the predictive relationship between FeNO and sputum eosinophil in uncontrolled asthmatic patients and the correlation between sputum eosinophil and FeNO in bronchial reversibility and bronchial hyperresponsiveness (BHR).
Methods: A total of 69 uncontrolled asthmatic patients were included in the study. All patients underwent a clinical assessment on the same day as follows: FeNO, spirometry with BHR or bronchodilator reversibility test and induced sputum in turn. Eosinophilic airway inflammation was defined as sputum eosinophil percentage (≥2.5%)/FeNO level (≥32 parts per billion [ppb]).
Results: FeNO level and sputum neutrophilic percentage were higher in the sputum eosinophilia group compared to those without (49 versus 27, p =0.011; 71.12 versus 87.67, p =0.012, respectively). Sputum eosinophil percentage was higher with raised FeNO level compared to those without (10.3% versus 2.75%, p =0.03). A significant correlation was observed between sputum eosinophil percentage and FeNO level (r =0.4016; p =0.0006). There were no significant relationships between sputum eosinophilic percentage and provocative dose (PD₂₀)/∆FEV₁ (improvement in a forced expiratory volume in 1 second [FEV₁] after 400μg of salbutamol), FeNO levels and PD₂₀/∆FEV₁. The FeNO level of 35.5 ppb was effective in assessing sputum eosinophilia, with a receiver operating characteristic area under curve (AUC) of 0.707 (p =0.011; 95% confidence interval [CI] 0.573–0.841), and 4.36% was the best diagnostic cutoff value of sputum eosinophil percentage for the FeNO level of 32 ppb (AUC 0.721; 95% CI 0.59–0.852).
Conclusion: FeNO level can accurately detect eosinophilic asthma but has limited value to assess noneosinophilic asthma in uncontrolled stage. Further studies are required to validate the use of FeNO level to determine an optimal cutoff for sputum eosinophilia that could be used in clinical practice.
Keywords: FeNO, sputum eosinophil, bronchial reversibility, BHR, asthma