Validity of fractional exhaled nitric oxide and small airway lung function measured by IOS in the diagnosis of cough variant asthma in preschool children with chronic cough

BACKGROUND: To investigate the role of combined impulse oscillometry (IOS) and fractional exhaled nitric oxide (FeNO) in the diagnosis of cough variant asthma (CVA) in preschool children.

METHODS: A total of 197 preschool-aged children with chronic cough were selected from the paediatric outpatient clinic.

Allergy histories were collected for all children along with IOS and FeNO.

Paediatric respiratory specialists divided the children into a CVA group (n = 90) and a noncough variant asthma (nCVA) group (n = 107) according to the diagnostic criteria for CVA After diagnostic treatment, the correlation between the FeNO and IOS values and the diagnosis in the two groups was analysed, and the area under the curve (AUC) of each index was calculated.

RESULTS: (1) X5 was significantly different between the CVA group and the nCVA group (− 4.22 vs. − 3.64, p < 0.001), as was the FeNO value (29.07 vs. 16.64, p < 0.001).

(2) Receiver operating characteristic (ROC) analysis showed that the AUCs of FeNO alone and X5 alone were 0.779 and 0.657, respectively, while the AUC of FeNO (cut-off value of 18 ppb) plus X5 (cut-off value of -4.15 cmH2O/(l/s)) reached 0.809.

CONCLUSIONS: Children with CVA may have small airway dysfunction at an early stage.

For preschool children with chronic cough, the combination of FeNO and X5 can better identify those with CVA.

Trial registration number: This trial was registered with and approved by the Chinese Clinical Trial Registry, with registration number ChiCTRcRRC-17011738, and was reviewed and approved by the Ethics Committee of Southwest Hospital.