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Feno : Influence of allergic rhinitis and atopy on its values

Faculdade de Medicina da Universidade do Porto Subject: Introdução à Medicina Professor: Dr. Altamiro Pereira Under the guidance of : Prof. Dr. João Fonseca and Dr. Luís da Silva Date: 28st May 2008. Systematic Review.

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Feno : Influence of allergic rhinitis and atopy on its values

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  1. Faculdade de MedicinadaUniversidade do Porto Subject: Introdução à Medicina Professor: Dr. Altamiro Pereira Under the guidance of: Prof. Dr. JoãoFonseca and Dr. Luísda Silva Date: 28st May 2008 Systematic Review Feno: Influence of allergic rhinitis and atopy on its values

  2. Index • Introduction • Work’s Background • Methods and Results • Main Results • Discussion FeNO: Influence of Allergic Rhinitis and Atopy on its values

  3. Introduction FeNO (Fractional Exhaled Nitric Oxide) is one of the tools used for asthma diagnosis. However, its use as a diagnostic test requires a standardized measurement technique due to the many confusion factors that can affect its values. These alterations have been recorded in literature but were never summarized. As such, the aim of our systematic review is to collect an analyze all the information on the influence of allergic rhinitis and atopy on FeNO and reach a conclusion about how their presence can modify its values in asthma diagnosis. FeNO: Influence of Allergic Rhinitis and Atopy on its values

  4. Index • Introduction • Work’s Background • Methods and Results • Main Results • Discussion FeNO: Influence of Allergic Rhinitis and Atopy on its values

  5. Work’s Background • Establish our systematic review’s aims • Improve the interpretation of FeNO values as a diagnostic test for asthma. • Assess how atopy and how allergic rhinitis affect exhaled nitric oxide values. • Define research questions: • How does atopy influence FeNO values? • How does allergic rhinitis influence FeNO values? • Search for an adequate query • This was used in the article search • (Exhaled nitric oxide OR Nitric oxide OR FeNO OR eNO) AND (“Allergic Rhinitis” OR Atopy OR “Skin prick test” OR “Prick test” OR “Ig E” OR “Specific Ig”) FeNO: Influence of Allergic Rhinitis and Atopy on its values

  6. Work’s Background • Define the inclusion and exclusion criteria • Define our variables for data extraction • Define how statistical analysis will be made FeNO: Influence of Allergic Rhinitis and Atopy on its values

  7. Index • Introduction • Work’s Background • Methods and Results • Main Results • Discussion FeNO: Influence of Allergic Rhinitis and Atopy on its values

  8. Methods and results FeNO: Influence of Allergic Rhinitis and Atopy on its values

  9. Methods and Results • Articles Search • Collecting Articles • Distributing the Articles • Selection phase • Read Title and Abstracts • Read Full Texts • Data Extraction • Process • Results • Statistical Analysis FeNO: Influence of Allergic Rhinitis and Atopy on its values

  10. Methods and Results • Articles Search • Collecting Articles • Distributing the Articles • Selection phase • Read Title and Abstracts • Read Full Texts • Data Extraction • Process • Results • Statistical Analysis FeNO: Influence of Allergic Rhinitis and Atopy on its values

  11. Methods and Results • Articles Search • Collecting Articles • Distributing the Articles FeNO: Influence of Allergic Rhinitis and Atopy on its values

  12. Methods and Results – Articles Search Collecting articles Article search: • Articles were searched in Scopus, Pubmed and ISI Web of Knowledge. • Limits used: published since 2001 language: English, Spanish or Portuguese Articles Organization • Data base creation with single articles copy • Total: 616 articles FeNO: Influence of Allergic Rhinitis and Atopy on its values

  13. Methods and Results – Articles Search Distributing the articles Article Distribution: Random attribution of articles between the reviewers and double read FeNO: Influence of Allergic Rhinitis and Atopy on its values

  14. Methods and Results • Articles Search • Collecting Articles • Distributing the Articles • Selection phase • Read Title and Abstracts • Read Full Texts • Data Extraction • Process • Results • Statistical Analysis FeNO: Influence of Allergic Rhinitis and Atopy on its values

  15. Methods and Results – Selection Phase Selection Phase • Inclusion/Exclusion of Titles and Abstracts • Inclusion/Exclusion of full-texts FeNO: Influence of Allergic Rhinitis and Atopy on its values

  16. Inclusion/ExclusionofTitlesandAbstracts FeNO: Influence of Allergic Rhinitis and Atopy on its values

  17. Methods and Results – Selection Phase Inclusion/Exclusion of Titles and Abstracts Discussion between the reviewers 3 rd Reviwer K = 0.4215 ± 0,22 K (ratio) =0.55 ± 0.30 PC (Yes) = 0,4401 ± 0,21 PC (No)= 0,7118 ± 0,15 FeNO: Influence of Allergic Rhinitis and Atopy on its values

  18. Methods and Results – Selection Phase FeNO: Influence of Allergic Rhinitis and Atopy on its values

  19. Inclusion/ExclusionofFullTexts FeNO: Influence of Allergic Rhinitis and Atopy on its values

  20. Methods and Results – Selection Phase Inclusion/Exclusion of full-texts Discussion between the reviewers K = 0,3509 ± 0,24 K (ratio) =0.46 ± 0,31 PC (Yes) = 0,3689 ± 0.18 PC (No)= 0,7066 ± 0,12 E-mail sent to theauthors FeNO: Influence of Allergic Rhinitis and Atopy on its values

  21. Methods and Results – Selection Phase FeNO: Influence of Allergic Rhinitis and Atopy on its values

  22. Methods and Results • Articles Search • Collecting Articles • Distributing the Articles • Selection phase • Read Title and Abstracts • Read Full Texts • Data Extraction • Process • Results • Statistical Analysis FeNO: Influence of Allergic Rhinitis and Atopy on its values

  23. Methods and Results – Data Extraction Data Extraction • Process • Results FeNO: Influence of Allergic Rhinitis and Atopy on its values

  24. Data Extraction - Process FeNO: Influence of Allergic Rhinitis and Atopy on its values

  25. Methods and Results – Data Extraction Data Extraction - Process • After reading some papers about factors that might confuse FeNO values we decided to extract information that might be relevant for future analysis and discussion. • We use a form for data extraction that summarize all important variables. Prevent missing values; increase the efficiency FeNO: Influence of Allergic Rhinitis and Atopy on its values

  26. Data Extraction - Results FeNO: Influence of Allergic Rhinitis and Atopy on its values

  27. Methods and Results – Data Extraction Data Extraction - Results FeNO: Influence of Allergic Rhinitis and Atopy on its values

  28. Methods and Results • Articles Search • Collecting Articles • Distributing the Articles • Selection phase • Read Title and Abstracts • Read Full Texts • Data Extraction • Process • Results • Statistical Analysis FeNO: Influence of Allergic Rhinitis and Atopy on its values

  29. Statistical Analysis FeNO: Influence of Allergic Rhinitis and Atopy on its values

  30. Methods and Results – Statistical Analysis Statistical Analysis • Afterextraction, data was transferred to a file were it can be analyzed with the proper tools • We organize the data following the sequence: • 1st: Factors Studied • 2nd: Age Group • 3rd: Allergic Rhinitis Assessment FeNO: Influence of Allergic Rhinitis and Atopy on its values

  31. Methods and Results – Statistical Analysis StatisticalAnalysis FeNO: Influence of Allergic Rhinitis and Atopy on its values

  32. Index • Introduction • Work’s Background • Methods and Results • Main Results • Discussion FeNO: Influence of Allergic Rhinitis and Atopy on its values

  33. MainResults FeNO: Influence of Allergic Rhinitis and Atopy on its values

  34. MainResults • General • QualitativeAnalysis • FactorsStudied • Age Groups • ConditionAssessment • Meta-analysis • ArticlesSelection • AllergicRhinitis • Atopy FeNO: Influence of Allergic Rhinitis and Atopy on its values

  35. MainResults - General FeNO: Influence of Allergic Rhinitis and Atopy on its values

  36. Main Results – General Results - General Data File FeNO: Influence of Allergic Rhinitis and Atopy on its values

  37. MainResults • General • QualitativeAnalysis • FactorsStudied • Age Groups • ConditionAssessment • Meta-analysis • ArticlesSelection • AllergicRhinitis • Atopy FeNO: Influence of Allergic Rhinitis and Atopy on its values

  38. MainResults – QualitativeAnalysis FeNO: Influence of Allergic Rhinitis and Atopy on its values

  39. Main Results – Qualitative Analysis QualitativeAnalysis – FactorsStudied Allergic Rhinitis 9 Atopy 2 Both 6 FeNO: Influence of Allergic Rhinitis and Atopy on its values

  40. Main Results – Qualitative Analysis QualitativeAnalysis - Age Groups FeNO: Influence of Allergic Rhinitis and Atopy on its values

  41. Main Results – Qualitative Analysis QualitativeAnalysis - ConditionAssessment FeNO: Influence of Allergic Rhinitis and Atopy on its values

  42. MainResults • General • QualitativeAnalysis • FactorsStudied • Age Groups • ConditionAssessment • Meta-analysis • ArticlesSelection • AllergicRhinitis • Atopy FeNO: Influence of Allergic Rhinitis and Atopy on its values

  43. Main Results - Meta-analysis FeNO: Influence of Allergic Rhinitis and Atopy on its values

  44. Main Results – Meta-analysis Meta-analysis: ArticlesSelection FeNO: Influence of Allergic Rhinitis and Atopy on its values

  45. Main Results – Meta-analysis Meta-analysis: AllergicRhinitis Causes for heterogeneity: - Age groups? FeNO: Influence of Allergic Rhinitis and Atopy on its values

  46. Main Results – Meta-analysis Meta-analysis: AllergicRhinitis • Child FeNO: Influence of Allergic Rhinitis and Atopy on its values

  47. Main Results – Meta-analysis Meta-analysis: AllergicRhinitis • Adults FeNO: Influence of Allergic Rhinitis and Atopy on its values

  48. Main Results – Meta-analysis Meta-analysis: Atopy Causes for heterogeneity: - Age Group? FeNO: Influence of Allergic Rhinitis and Atopy on its values

  49. Main Results – Meta-analysis Meta analysis: Atopy • Child • Adults FeNO: Influence of Allergic Rhinitis and Atopy on its values

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