RT Journal Article SR Electronic T1 Accuracy of FENO for diagnosing asthma: a systematic review JF Thorax JO Thorax FD BMJ Publishing Group Ltd and British Thoracic Society SP 109 OP 116 DO 10.1136/thoraxjnl-2016-208704 VO 72 IS 2 A1 Karrasch, Stefan A1 Linde, Klaus A1 Rücker, Gerta A1 Sommer, Harriet A1 Karsch-Völk, Marlies A1 Kleijnen, Jos A1 Jörres, Rudolf A A1 Schneider, Antonius YR 2017 UL http://thorax.bmj.com/content/72/2/109.abstract AB Background Measurement of FENO might substitute bronchial provocation for diagnosing asthma. We aimed to investigate the diagnostic accuracy of FENO measurement compared with established reference standard.Methods Systematic review and diagnostic meta-analysis. Data sources were Medline, Embase and Scopus up to 29 November 2015. Sensitivity and specificity were estimated using a bivariate model. Additionally, summary receiver-operating characteristic curves were estimated.Results 26 studies with 4518 participants (median 113) were included. Risk of bias was considered low for six of seven items in five studies and for five items in seven studies. The overall sensitivity in the meta-analysis was 0.65 (95% CI 0.58 to 0.72), the overall specificity 0.82 (0.76 to 0.86), the diagnostic OR 9.23 (6.55 to 13.01) and the area under the curve 0.80 (0.77 to 0.85). In meta-regression analyses, higher cut-off values were associated with increasing specificity (OR 1.46 per 10 ppb increase in cut-off) while there was no association with sensitivity. Sensitivities varied significantly within the different FENO devices, but not specificities. Neither prevalence, age, use of bronchoprovocation in >90% of participants or as exclusive reference standard test, nor risk of bias were significantly associated with diagnostic accuracy.Conclusions There appears to be a fair accuracy of FENO for making the diagnosis of asthma. The overall specificity was higher than sensitivity, which indicates a higher diagnostic potential for ruling in than for ruling out the diagnosis of asthma.