Diagnostic accuracy of fractional exhaled nitric oxide (FeNO) with or without blood eosinophils in childhood, adolescent, and adult asthma: protocol for a systematic review and meta-analysis
Bibliographic record
Abstract
ABSTRACT Introduction Asthma poses a diagnostic challenge due to its intermittent symptoms and variable airflow obstruction. Diagnostic assessments such as spirometry and bronchodilator response are frequently non-diagnostic, necessitating confirmatory bronchial provocation testing. Biomarkers of type-2 inflammation —exhaled nitric oxide (FeNO) and blood eosinophil counts (BEC)— are useful in asthma, but their diagnostic values in children and in combination (FeNO+BEC) are unclear. This systematic review will evaluate the diagnostic accuracy of FeNO alone or in combination with BEC in paediatric and adult asthma. Methods and Analysis This protocol is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. The review will include studies of any design on the diagnostic accuracy of FeNO with or without BEC in asthma compared to the reference standards bronchodilator response and provocation testing in patients ≥ 5 years old selected from MEDLINE, Embase, and Cochrane CENTRAL databases. Screening, study selection, and data extraction will be independently performed by two reviewers. Risk of bias will be assessed using QUADAS-2 and QUADAS-C. Meta-analysis will be carried out by pooling the sensitivity and specificity of FeNO alone or in combination with BEC in a bivariate random effects model allowing the generation of summarised operating characteristic curves and summary points. Further analysis utilising a multiple thresholds model will enable the computation of diagnostic thresholds for FeNO. Ethics and Dissemination No patient data will be stored without prior approval from ethics committee. The findings will be submitted in a peer-reviewed publication. Registration PROSPERO CRD42023489738 SOCIAL MEDIA MESSAGE Diagnosing asthma is challenging. Spirometry and bronchodilator reversibility are often non-diagnostic, calling for provocation testing. Our systematic review will explore complementary approaches using FeNO with and without the blood eosinophil count.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.081 | 0.150 |
| Meta-epidemiology (narrow) | 0.007 | 0.006 |
| Meta-epidemiology (broad) | 0.028 | 0.040 |
| Bibliometrics | 0.011 | 0.011 |
| Science and technology studies | 0.003 | 0.005 |
| Scholarly communication | 0.008 | 0.007 |
| Open science | 0.006 | 0.005 |
| Research integrity | 0.009 | 0.007 |
| Insufficient payload (model declined to judge) | 0.049 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".