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Korean J Pediatr 2017 September;60(9) :290-295.
Published online 2017 September 15.       
Accuracy of maximal expiratory flow-volume curve curvilinearity and fractional exhaled nitric oxide for detection of children with atopic asthma
Sang Hoo Park1, Min Ji Im1, Sang-Yong Eom2, Youn-Soo Hahn1
1Department of Pediatrics, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
2Department of Preventive Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
Corresponding Author: Youn-Soo Hahn ,Tel: +82-43-269-6042, Fax: +82-43-264-6620, Email:
Copyright © 2017 by The Korean Pediatric Society
Purpose: Airway pathology in children with atopic asthma can be reflected by the concave shape of the maximal expiratory flow-volume (MEFV) curve and high fractional exhaled nitric oxide (FeNO) values. We evaluated the capacity of the curvilinearity of the MEFV curve, FeNO, and their combination to distinguish subjects with atopic asthma from healthy individuals.
Methods: FeNO and angle , which characterizes the general configuration of the MEFV curve, were determined in 119 steroid-naïve individuals with atopic asthma aged 8 to 16 years, and in 92 age-matched healthy controls. Receiver operating characteristic (ROC) curve analyses were performed to determine the cutoff points of FeNO and angle that provided the best combination of sensitivity and specificity for asthma detection.
Results: Asthmatic patients had a significantly smaller angle and higher FeNO compared with healthy controls (both, P<0.001). For asthma detection, the best cutoff values of angle and FeNO were observed at 189.3 and 22 parts per billion, respectively. The area under the ROC curve for the combination of angle and FeNO improved to 0.91 (95% confidence interval [CI], 0.87–0.95) from 0.80 (95% CI, 0.75–0.86; P<0.001) for angle alone and 0.86 (95% CI, 0.82–0.91; P=0.002) for FeNO alone. In addition, the combination enhanced sensitivity with no significant decrease in specificity.
Conclusion: These data suggest that the combined use of the curvilinearity of the MEFV curve and FeNO is a useful tool to differentiate between children with and without atopic asthma.
Keywords: Asthma | Child | Nitric oxide | Maximal expiratory flow-volume curve | Pulmonary function testing
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Supplementary Material  Supplementary Material
House dust mite-specific immunoglobulin E and longitudinal exhaled nitric oxide measurements in children with atopic asthma  2015 March;58(3)
Association of wheezing phenotypes with fractional exhaled nitric oxide in children  2014 May;57(5)
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