J Korean Med Sci.  2017 Mar;32(3):439-447. 10.3346/jkms.2017.32.3.439.

Relationship between Fractional Exhaled Nitric Oxide Level and Efficacy of Inhaled Corticosteroid in Asthma-COPD Overlap Syndrome Patients with Different Disease Severity

• Feng JX
• Lin Y
• Lin J
• He SS
• Chen MF
• Wu XM
• Xu YZ

• KMID: 2366640
• DOI: http://doi.org/10.3346/jkms.2017.32.3.439

Abstract

This study explored the relationship between the fractional exhaled nitric oxide (FeNO) level and the efficacy of inhaled corticosteroid (ICS) in asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) patients with different disease severity. A total of 127 ACOS patients with ACOS (case group) and 131 healthy people (control group) were enrolled in this study. Based on the severity of COPD, the ACOS patients were divided into: mild ACOS; moderate ACOS; severe ACOS; and extremely severe ACOS groups. We compared FeNO levels, pulmonary function parameters including percentage of forced expiratory volume in 1 second (FEV1) to predicted value (FEV1%pred), ratio of FEV1 to forced vital capacity (FEV1/FVC), inspiratory capacity to total lung capacity (IC/TLC) and residual volume to total lung capacity (RV/TLC), arterial blood gas parameters, including PH, arterial partial pressure of oxygen (PaOâ‚‚) and arterial partial pressure of carbon dioxide (PaCOâ‚‚), total serum immunoglobulin E (IgE), induced sputum eosinophil (EOS), plasma surfactant protein A (SP-A), plasma soluble receptor for advanced glycation end products (sRAGE), sputum myeloperoxidase (MPO), sputum neutrophil gelatinase-associated lipocalin (NGAL) and Asthma Control Test (ACT) scores, and COPD Assessment Test (CAT) scores. Compared with pre-treatment parameters, the FeNO levels, RV/TLC, PaCOâ‚‚, total serum IgE, induced sputum EOS, plasma SP-A, sputum MPO, sputum NGAL, and CAT scores were significantly decreased after 6 months of ICS treatment, while FEV1%pred, FEV1/FVC, IC/TLC, PH, PaOâ‚‚, plasma sRAGE, and ACT scores were significantly increased in ACOS patients with different disease severity after 6 months of ICS treatment. This finding suggests that the FeNO level may accurately predict the efficacy of ICS in the treatment of ACOS patients.

Keyword

Fractional Exhaled Nitric Oxide; Inhaled Corticosteroid; Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome; Efficacy

MeSH Terms

Animals
Asthma
Carbon Dioxide
Cats
Eosinophils
Forced Expiratory Volume
Glycosylation End Products, Advanced
Humans
Hydrogen-Ion Concentration
Immunoglobulin E
Immunoglobulins
Inspiratory Capacity
Lipocalins
Lung Diseases, Obstructive
Neutrophils
Nitric Oxide*
Oxygen
Partial Pressure
Peroxidase
Plasma
Pulmonary Disease, Chronic Obstructive
Pulmonary Surfactant-Associated Protein A
Residual Volume
Sputum
Total Lung Capacity
Vital Capacity
Carbon Dioxide
Glycosylation End Products, Advanced
Immunoglobulin E
Immunoglobulins
Lipocalins
Nitric Oxide
Oxygen
Peroxidase
Pulmonary Surfactant-Associated Protein A

Figure

• 

  Fig. 1 Comparisons of FeNO levels in ACOS patients with different disease severity and the control group before and after treatment. A = mild ACOS group, B = moderate ACOS group, C = severe ACOS group, D = extremely severe ACOS group, FeNO = fractional exhaled nitric oxide, Before = before the 6-month treatment, After = after the 6-month treatment, ACOS = asthma-chronic obstructive pulmonary disease overlap syndrome. *P < 0.05, compared with the control group before treatment; †P < 0.05, compared with the control group after treatment; ‡P < 0.05 when compared with the mild ACOS, moderate ACOS, severe ACOS, extremely severe ACOS, and control groups.

• 

  Fig. 2 Comparisons of pulmonary function in ACOS patients with different disease severity and control group before and after treatment. ACOS = asthma-chronic obstructive pulmonary disease overlap syndrome, A = mild ACOS group, B = moderate ACOS group, C = severe ACOS group, D = extremely severe ACOS group, FEV1%pred = percentage of forced expiratory volume in 1 second (FEV1) to predicted value, FEV1/FVC = the ratio of FEV1 to forced vital capacity, IC/TLC = ratio of inspiratory capacity to total lung capacity, RV/TLC = ratio of residual volume to total lung capacity, Before = before the 6-month treatment, After = after the 6-month treatment. *P < 0.05, compared with the control group before treatment; †P < 0.05, compared with the control group after treatment; ‡P < 0.05 when compared with the mild ACOS, moderate ACOS, severe ACOS, extremely severe ACOS, and control groups before treatment.

• 

  Fig. 3 Comparisons of the levels of plasma SP-A, plasma sRAGE, sputum MPO, and sputum NGAL in ACOS patients with different disease severity and control group before and after treatment. ACOS = asthma-chronic obstructive pulmonary disease overlap syndrome, A = mild ACOS group, B = moderate ACOS group, C = severe ACOS group, D = extremely severe ACOS group, MPO = sputum myeloperoxidase, NGAL = sputum neutrophil gelatinase-associated lipocalin; sRAGE = plasma soluble receptor for advanced glycation end products, SP-A = plasma surfactant protein A, Before = before the 6-month treatment, After = after the 6-month treatment. *P < 0.05, compared with the control group before treatment; †P < 0.05, compared with the control group after treatment; ‡P < 0.05, compared with the mild ACOS, moderate ACOS, severe ACOS, extremely severe ACOS, and control groups.

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