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Introdução à Medicina 2006/2007 Class 3, First Year João Almeida Lopes Fonseca

The Use of Exhaled Nitric Oxide and Induced Sputum Eosinophilia in the Diagnosis of Asthma – a systematic review –. Introdução à Medicina 2006/2007 Class 3, First Year João Almeida Lopes Fonseca Altamiro Manuel Rodrigues da Costa Pereira. Summary. Introduction Current Tests

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Introdução à Medicina 2006/2007 Class 3, First Year João Almeida Lopes Fonseca

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  1. The Use of Exhaled Nitric Oxide and Induced Sputum Eosinophilia in the Diagnosis of Asthma– a systematic review – Introdução à Medicina 2006/2007 Class 3, First Year João Almeida Lopes Fonseca Altamiro Manuel Rodrigues da Costa Pereira

  2. Summary • Introduction • Current Tests • Inflammatory Biomarkers • Aim • Methods • Study Design • Data source • Study Selection • Quality Criteria • Statistical Analysis • Flow Chart • Results • Gantt chart

  3. Introduction • Asthma is an inflammatory disorder • Asthma diagnosis: • Mostly based on the clinical observation complemented with lung function tests • Bronchodilatation and hiperreactivity tests (methacholine) • There is growing interest in exhaled nitric oxide (Fe(NO)) and induced sputum eosinophilia

  4. Introduction Current Tests Tests Parameters GINA. 2006 Nov Dundas I. Thorax. 2005 Jan Busse WW. Am J Respir Crit Care Med.2005 Oct

  5. Introduction Inflammatory Biomarkers Tests Parameters Lemiere Cet al. Can J Physiol Pharmacol. 2006 Jan Joos GF et al.Curr Opin Pharmacol. 2003 Jun Dinakar C et al. Curr Allergy Asthma Rep. 2004 Nov Kim CK et al. Ann Allergy Asthma Immunol. 2004 Aug

  6. Introduction Aim To evaluate the sensitivityand the specificity of Fe(NO) and induced sputum eosinophilia in asthma diagnosis

  7. Methods Study Design A meta-analysis of the published studies on the sensitivity and specificity of measurements of Fe(NO)andinduced sputum eosinophilia

  8. Methods Data source Research was made using Medline,Scopus and references of used articles. • Query of Medline was: (("Asthma"[MeSH] OR Asthma OR Asthm*) AND (("Nitric Oxide"[MeSH] OR feno OR ENO OR exhaled air) OR ((Eosinophil[MeSH] OR Eosinophil* OR Eosinophilia[MeSH])AND (Sputum[MeSH] OR Sputum))) AND ((sensitiv*[Title/Abstract] OR sensitivity and specificity[MeSH Terms] OR diagnos*[Title/Abstract] OR diagnosis[MeSH:noexp] OR diagnostic * [MeSH:noexp] OR diagnosis,differential[MeSH:noexp] OR diagnosis[Subheading:noexp] OR (Diagnosis[MeSH] OR Diagnosis OR Diagnos*))

  9. Methods Data source • Query of Scopus was: (((asthma OR asthm) AND ((nitric oxide OR feno OR eno OR exhaled air) OR (eosinophil OR eosinophilia) AND sputum)) AND (((sensitiv OR sensitivity) AND specificity) OR (diagnostic OR differential diagnosis OR diagnosis)))AND PUBYEAR AFT 1991

  10. Methods Study Selection • Six groups of two reviewers - titles/abstracts • Six groups of two reviewers - full text • Articles atributted randomly using excel • Checked inclusion and exclusion criteria to select the articles • 1st stage: titles/abstracts • 2nd stage: full text.

  11. Methods Study Selection • Non-agreement on 1st stage: • The article is included • Non-agreement on 2nd stage solved by: • Consensus or • A third reviewer (a specialist in the field).

  12. Methods Study Selection Inclusion criteria • Studies the use of exhaled nitric oxide or eosinophil levels in induced sputum for the diagnosis of asthma in humans. • Reports original data on the sensitivity and specificity of the application of inflammatory biomarkers Exclusion criteria • Not written in English, Portuguese, French or Spanish. • Full text not available via Medline, Scopus or FMUP library. • Does not describe the criteria use for the diagnosis of asthma

  13. Methods Quality Criteria • The articles included were evaluated regarding their methodological quality using a scale based on STARD. http://www.consort-statement.org/stardstatement.htm

  14. Methods Statistical Analysis • Meta-Disc 1.4 and SPSS 14.0 - Relevant information extracted from the chosen articles was registered. • Main parameters - Sensitivity and Specifity of inflammatory biomarkers: • Nitric oxide • Eosinophils • Kappa Statistics -compares the agreement against that which might be expected by chance.

  15. Flow chart

  16. ResultsProportionofInclusion/Exclusion – PubmedandScopus

  17. ResultsDegreeofConcordance -Titles/AbstractsandFullTexts

  18. ResultsExclusion Criteria – Titles/Abstracts and Full Texts

  19. Data extraction

  20. Data extraction

  21. Quality Assessment • The first three articles with the better quality evaluation: • Pijnenburg, MW - Thorax – 2005 – 23,5 pts • Hefflera, E - Respiratory Medicine – 2006 – 19,5 pts • Efthimiadis, A - The Journal of Allergy and Clinical Immunology – 2000 – 18,5 pts Highest pontuation – 23,5 points

  22. Introduction Methods Results Discussion Full Article PDF Presentations st 1 Abstract PP nd 2 Gantt chart rd 3 Authors Flow chart Full Article HTML Related Sites Site Map HOME Appendix Site Map

  23. Gantt chart

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