Diagnosing asthma - Comparisons between exhaled nitric oxide measurements and conventional tests

International guidelines recommend a range of clinical tests to confirm the diagnosis of asthma. These focus largely on identifying variable airflow obstruction and responses to bronchodilator or corticosteroid. More recently, exhaled nitric oxide (FENO) measurements and induced sputum analysis to assess airway inflammation have been highlighted. However, to date, no systematic comparisons to confirm the diagnostic utility of each of these methods have been performed. To do so, we investigated 47 consecutive patients with symptoms suggestive of asthma, using a comprehensive fixed-sequence series of diagnostic tests. Sensitivities and specificities were obtained for peak flow measurements, spirometry, and changes in these parameters after a trial of steroid. Comparisons were made against FENO and sputum cell counts. Sensitivities for each of the conventional tests (0-47%) were lower than for FENO (88%) and sputum eosinophils (86%). Overall, the diagnostic accuracy when using FENO. and sputum eosinophils was significantly greater. Results for conventional tests were not improved, using a trial of steroid. We conclude that FENO measurements and induced sputum analysis are superior to conventional approaches, with exhaled nitric oxide being most advantageous because the test is quick and easy to perform.