Tuberc Respir Dis.  2020 Jan;83(1):42-50. 10.4046/trd.2019.0050.

Exhaled Nitric Oxide in Patients with Stable Chronic Obstructive Pulmonary Disease: Clinical Implications of the Use of Inhaled Corticosteroids

• Jo YS
• Choe J
• Shin SH
• Koo HK
• Lee WY
• Kim YI
• Ra SW
• Yoo KH
• Jung KS
• Park HY
• Park YB

• KMID: 2466619
• DOI: http://doi.org/10.4046/trd.2019.0050

Abstract

BACKGROUND
Fractional exhaled nitric oxide (FeNO) is regarded as a potential biomarker for identifying eosinophilic inflammation. We aimed to evaluate the clinical implication of FeNO and its influence on inhaled corticosteroids (ICS) prescription rate in Korean chronic obstructive pulmonary disease (COPD) patients.
METHODS
FeNO level and its association with clinical features were analyzed. Changes in the prescription rate of ICS before and after FeNO measurement were identified.
RESULTS
A total of 160 COPD patients were divided into increased (≥25 parts per billion [ppb], n=74) and normal (<25 ppb, n=86) FeNO groups according to the recommendations from the American Thoracic Society. Compared with the normal FeNO group, the adjusted odds ratio for having history of asthma without wheezing and with wheezing in the increased FeNO group were 2.96 (95% confidence interval [CI], 1.40-6.29) and 4.24 (95% CI, 1.37-13.08), respectively. Only 21 out of 74 patients (28.4%) with increased FeNO prescribed ICS-containing inhaler and 18 of 86 patients (20.9%) with normal FeNO were given ICS-containing inhaler. Previous exacerbation, asthma, and wheezing were the major factors to maintain ICS at normal FeNO level and not to initiate ICS at increased FeNO level.
CONCLUSION
Increased FeNO was associated with the history of asthma irrespective of wheezing. However, FeNO seemed to play a subsidiary role in the use of ICS-containing inhalers in real-world clinics, which was determined with prior exacerbation and clinical features suggesting Th2 inflammation.

Keyword

Chronic Obstructive Pulmonary Disease; Fractional Exhaled Nitric Oxide; Inhaled Corticosteroids

MeSH Terms

Adrenal Cortex Hormones*
Asthma
Eosinophils
Humans
Inflammation
Nebulizers and Vaporizers
Nitric Oxide*
Odds Ratio
Prescriptions
Pulmonary Disease, Chronic Obstructive*
Respiratory Sounds
Adrenal Cortex Hormones
Nitric Oxide

Figure

• 

  Figure 1 Correlation between blood eosinophil count and fractional exhaled nitric oxide (FeNO).

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  Figure 2 Forest plots for odds ratio (OR) of clinical phenotype according to patient classification based on fractional exhaled nitric oxide (FeNO) value: (A) unadjusted, and (B) adjusted data. Adjusted for age, sex, smoking status and forced expiratory volume in 1 second <50% predicted. COPD: chronic obstructive pulmonary disease; ppb: parts per billion; BA: bronchial asthma; CI: confidence interval; aOR: adjusted OR.

• 

  Figure 3 Changes in prescription status of inhaled corticosteroid (ICS) before and after measurement of fractional exhaled nitric oxide (FeNO) levels.

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