Screening for asthma among women referred for fertility treatment using a symptom questionnaire and fractional exhaled nitric oxide.
4 affiliations
- 1Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark.
- 2Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- 3The Fertility Clinic, Department of Gynecology and Obstetrics, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark.
- 4Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Abstract
Introduction
Asthma, a highly prevalent disorder among women of reproductive age, is associated with infertility and adverse pregnancy outcomes. Well-controlled asthma likely improves fertility and pregnancy outcomes, yet asthma is underdiagnosed. Therefore, we evaluated the value of the 'Life Quality Test (LQT)' from the American College of Asthma, Allergy and Immunology and fractional exhaled nitric oxide (FeNO) as a screening tool for current asthma among women referred for fertility treatment, as they may benefit from further assessment.Methods
A cross-sectional observational study was set up within the PRO-ART study. Women referred for fertility treatment at four Danish hospitals completed the LQT-survey. Those with affirmative responses were invited for a screening visit with spirometry, bronchial provocation, and FeNO measurement. Asthma diagnosis was based on bronchial provocation. Associations between asthma, FeNO, and LQT-scores were assessed using logistic regression. A grid-search algorithm identified thresholds for an effective screening tool.Results
Of 188 women screened, 119 (63.3%) had asthma, of whom 47 (39.4%) had no previous asthma diagnosis. FeNO alone was weakly predictive (OR 1.04, p = 0.036), while LQT-scores were stronger predictors for asthma (OR 1.40, p < 0.001). Combined, FeNO and LQT-scores revealed good predictive value (AUC = 0.82). A screening algorithm with combined criteria of LQT ≥ 7, FeNO ≥ 25 ppb, or 5 ≤ LQT < 7 with FeNO 12-25 ppb achieved 87.9% sensitivity and 55.4% specificity.Conclusion
Undiagnosed asthma is common among women referred for fertility treatment. Combining FeNO and LQT-score provides a feasible, non-invasive screening method for probable asthma, warranting validation in larger cohorts.
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BibTeX
@article{miller2026screening,
title = {{Screening for asthma among women referred for fertility treatment using a symptom questionnaire and fractional exhaled nitric oxide.}},
author = {Oscar Nyholm Miller and Anne Vejen Hansen and Casper Tidemandsen and Emilia Yifei Huang and Nina la Cour Freiesleben and Vibeke Backer and Charlotte Suppli Ulrik},
journal = {European clinical respiratory journal},
year = {2026},
month = oct,
doi = {10.1080/20018525.2026.2728866},
url = {https://europepmc.org/article/MED/42899102},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Screening for asthma among women referred for fertility treatment using a symptom questionnaire and fractional exhaled nitric oxide.
AU - Oscar Nyholm Miller
AU - Anne Vejen Hansen
AU - Casper Tidemandsen
AU - Emilia Yifei Huang
AU - Nina la Cour Freiesleben
AU - Vibeke Backer
AU - Charlotte Suppli Ulrik
PY - 2026
DA - 2026/10/16
JO - European clinical respiratory journal
DO - 10.1080/20018525.2026.2728866
UR - https://europepmc.org/article/MED/42899102
AB - Introduction Asthma, a highly prevalent disorder among women of reproductive age, is associated with infertility and adverse pregnancy outcomes. Well-controlled asthma likely improves fertility and pregnancy outcomes, yet asthma is underdiagnosed. Therefore, we evaluated the value of the 'Life Quality Test (LQT)' from the American College of Asthma, Allergy and Immunology and fractional exhaled nitric oxide (FeNO) as a screening tool for current asthma among women referred for fertility treatment, as they may benefit from further assessment.Methods A cross-sectional observational study was set up within the PRO-ART study. Women referred for fertility treatment at four Danish hospitals completed the LQT-survey. Those with affirmative responses were invited for a screening visit with spirometry, bronchial provocation, and FeNO measurement. Asthma diagnosis was based on bronchial provocation. Associations between asthma, FeNO, and LQT-scores were assessed using logistic regression. A grid-search algorithm identified thresholds for an effective screening tool.Results Of 188 women screened, 119 (63.3%) had asthma, of whom 47 (39.4%) had no previous asthma diagnosis. FeNO alone was weakly predictive (OR 1.04, p = 0.036), while LQT-scores were stronger predictors for asthma (OR 1.40, p < 0.001). Combined, FeNO and LQT-scores revealed good predictive value (AUC = 0.82). A screening algorithm with combined criteria of LQT ≥ 7, FeNO ≥ 25 ppb, or 5 ≤ LQT < 7 with FeNO 12-25 ppb achieved 87.9% sensitivity and 55.4% specificity.Conclusion Undiagnosed asthma is common among women referred for fertility treatment. Combining FeNO and LQT-score provides a feasible, non-invasive screening method for probable asthma, warranting validation in larger cohorts.
SN - 2001-8525
ER -