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Measurement of exhaled nitric oxide as a potential screening tool for pulmonary tuberculosis

Authors: Van Beek, S. C.1; Nhung, N. V.2; Sy, D. N.2; Sterk, P. J.3; Tiemersma, E. W.4; Cobelens, F. G. J.4

Source: The International Journal of Tuberculosis and Lung Disease, Volume 15, Number 2, February 2011 , pp. 185-191(7)

Publisher: International Union Against Tuberculosis and Lung Disease

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BACKGROUND: There is a need for low-technology, inexpensive screening tools for active tuberculosis (TB) case finding.

OBJECTIVE: To assess the potential usefulness of measuring exhaled nitric oxide (eNO).

DESIGN: Cross-sectional comparison in Hanoi, Viet Nam, comparing 90 consecutive smear-positive, culture-confirmed TB patients presenting at a referral hospital with office workers (no X-ray confirming TB) at this hospital (n = 52) and at a construction firm (n = 84). eNO levels were analysed using a validated handheld analyser.

RESULTS: eNO levels among TB patients (median 15 parts per billion [ppb], interquartile range [IQR] 10–20) were equal to those among construction firm workers (15 ppb, IQR 12–19, P = 0.517) but higher than those among hospital workers (8.5 ppb, IQR 5–12.5, P < 0.001). Taking the hospital workers as the comparison group, best performance as a diagnostic tool was at a cut-off of 10 ppb, with sensitivity 78% (95%CI 68–86) and specificity 62% (95%CI 47–75). Test characteristics could be optimised to 84% vs. 67% by excluding individuals who had recently smoked or consumed alcohol.

CONCLUSION: While eNO measurement has limited value in the direct diagnosis of pulmonary TB, it may be worth developing and evaluating as a cost-effective replacement of chest X-ray in screening algorithms of pulmonary TB where X-ray is not available.

Keywords: active case finding; exhaled nitric oxide; pulmonary; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Leiden University Medical Centre, Leiden, The Netherlands 2: National Lung Hospital, Hanoi, Viet Nam 3: Department of Pulmonology, Academic Medical Centre, Amsterdam, The Netherlands 4: KNCV Tuberculosis Foundation, The Hague, The Netherlands; and Centre for Poverty-related Communicable Diseases, Amsterdam Institute of Global Health and Development, Academic Medical Centre, Amsterdam, The Netherlands

Publication date: February 1, 2011

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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