Cough variant asthma (CVA), a common asthma phenotype characterized by nonproductive
cough and bronchial hyperreactivity (BHR), is usually detected by bronchial provocation tests
(BPTs) which are time-consuming, expensive, and unsafe. The primary study objective was to
provide proof of concept for the use of fractional exhaled nitric oxide (FENO), eosinophil count
percentage in induced sputum (sEOS%), forced expiratory flow between 25 and 75% of
forced vital capacity (FEF25–75%) % predicted value, and FEF25–75% z-scores as surrogate
markers predicting BHR in young adults with suspected CVA; the secondary objective was to
compare the diagnostic performance of the various techniques. Three hundred and ten
subjects (median age 24 years) were included in a cross-sectional study. Subjects were
characterized as BHR positive (POS) (n 147) or BHR negative (NEG) (n 163) according to
methacholine BPT. Classification accuracies were expressed as areas under the receiver
operator characteristic curves (AUC). Compared with BHR NEG, FEF25–75% % predicted
value and FEF25–75% z-scores were lower in the BHR POS group (p < 0.001), whereas FENO
(p < 0.001) and sEOS% were higher (p < 0.001). AUC values for detecting BHR were
as follows: FENO, 0.98 (SD 0.02); sEOS%, 0.98 (SD 0.02); FEF25–75% % pred, 0.93
(SD 0.05); FEF25–75% z scores, 0.92 (SD 0.05). Optimal cutoff values (OCV) for BHR
prediction were as follows: FENO, 32.7 ppb (sensitivity 0.93, specificity 0.96), sEOS
%, 3.80% (sensitivity 0.94, specificity 0.94), FEF25–75% % predicted value, 80.0%
(sensitivity 0.90, specificity 0.87), and FEF25–75% z-score, −0.87 (sensitivity 0.89,
specificity 0.87). Non-invasive/semi-invasive airway inflammatory or small airway
functional measures might be used as surrogate markers predicting BHR in young
adults with suspected CV