Study of the Correlation Between Bronchial Hyperresponsiveness and Exhaled Nitric Oxide in Subjects with Suspected Symptoms of Asthma

Background: Bronchial hyperresponsiveness (BHR) is one of main features of asthma within chronic inflammation and reversible bronchoconstriction. Actually, methacholine challenge is useful method to detect BHR in subjects with suspected asthma symptoms. However, this method has some limitations due to its safety and side effects. The measure of exhaled nitric oxide (NO) demonstrates currently as the alternative method for methacholine challenge. Methods: Ninety-five subjects had at least one of the following symptoms were included in this study: wheezing or chest tightness during exercise, chronic cough, or nocturnal coughing. They were divided into two groups depending on the positivity or negativity of BHR. Lung function test, exhaled NO measurement, and methacholine challenge were done for each study subject. Results: There were no significant differences between two groups for age and male/female ratio (41 ± 22 vs 38 ± 23 years old and 0.9 vs 1.1; P > 0.05 and P > 0.05; respectively). The percentage of wheezing and nocturnal coughing in subjects with positive BHR (BHR+) was significantly higher than that in subjects with negative BHR (BHR-: 70.9% and 64.5% vs 31.2% and 45.1%; P<0.001 and P<0.01; respectively). FENO measured at 50 mL/s in subjects with BHR+ was significantly higher subjects with BHR- (36 ± 10 ppb vs 11 ± 9 ppb; P<0.001). There was a significant correlation between FENO-50 mL/s and methacholine dose in subjects with BHR+ (R= -0.695; P<0.001). FENO-50 mL/s at 35 ppb had 86.7% of sensibility and 82.9% of specificity for diagnosis of BHR. Conclusion: FENO is a useful biomarker for diagnosis of asthma in subjects with suspected symptoms of asthma. FENO level has a high sensitivity and specificity for screening out subjects with BHR. The measurement of exhaled NO may be an alternative method for detecting BHR in diagnosis of asthma in clinical practice.