Characterization of airway inflammation in patients with COPD using fractional exhaled nitric oxide levels: a pilot study

Donohue, James F.; Herje, Nancy; Crater, Glenn; Rickard, Kathleen

doi:10.2147/copd.s44552

Cited by 53 publications

(46 citation statements)

References 22 publications

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“…Some studies have reported that patients with high FeNO levels will have a good response to corticosteroids and greater improvement in FEV 1 39,40. The reason for this result may be due to the fact that the FeNO level correlated well with the eosinophils, which is a good predictor for the response to corticosteroids 41,42. Antus et al43 pointed out that the optimum cutoff point for FENO as a predictor for significant increase in FEV 1 was 26.8 ppb (sensitivity: 74% and specificity: 75%).…”

Section: Methodsmentioning

confidence: 99%

The recent advances of phenotypes in acute exacerbations of COPD

Zhou

Zhao

et al. 2017

COPD

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Exacerbations of COPD are clinically relevant events with therapeutic and prognostic implications. Yet, significant heterogeneity of clinical presentation and disease progression exists within acute exacerbations of COPD (AECOPD). Currently, different phenotypes have been widely used to describe the characteristics among patients with AECOPD. This has proved to be significant in the treatment and prediction of the outcomes of the disease. In this review of published literature, the phenotypes of AECOPD were classified according to etiology, inflammatory biomarkers, clinical manifestation, comorbidity, the frequency of exacerbations, and so on. This review concentrates on advancements in the use of phenotypes of AECOPD.

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Section: Methodsmentioning

confidence: 99%

The recent advances of phenotypes in acute exacerbations of COPD

Zhou

Zhao

et al. 2017

COPD

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“…Eosinophilic airway inflammation can be measured through the airway noninvasively by induced sputum analysis and fractional exhaled nitric oxide (FeNO) 4. Both are considered as a direct, reliable, sensitive, simple, and repeatable method of assessing inflammatory phenotypes, widely used in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Correlation between fractional exhaled nitric oxide and sputum eosinophilia in exacerbations of COPD

Gao¹,

Zhang

Zhou³

et al. 2017

COPD

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IntroductionMeasurements of eosinophils in induced sputum and fractional exhaled nitric oxide (FeNO) are noninvasive biomarkers for assessing airway inflammation phenotypes in chronic obstructive pulmonary disease (COPD). Nevertheless, the clinical application of the correlation between FeNO levels and sputum eosinophilia is controversial. The study aimed to investigate the correlation and predictive relationship between FeNO levels and sputum eosinophils in patients with COPD exacerbation. It also examined the relationship between FeNO levels and blood eosinophil percentage.MethodsA total of 163 patients with COPD exacerbation were included in the cross-sectional study. All patients underwent the following on the same day: FeNO test, spirometry, bronchodilator reversibility test, induced sputum, and routine blood test. They were classified as eosinophilic group or noneosinophilic group based on sputum eosinophilic percentage (≥2.5%)/FeNO levels (≥32 parts per billion [ppb]).ResultsFeNO levels and blood eosinophilic percentage were higher in patients with sputum eosinophilia (n=62) compared to those without (31.35 ppb versus 21.43 ppb, P=0.015; 2.71% versus 0.98%, P<0.0001, respectively). Sputum eosinophilic percentage was higher with raised FeNO (n=34) compared to those with FeNO <32 ppb (5.12% versus 3.12%, P=0.007). Eosinophils in induced sputum correlated with both FeNO levels (ρ=0.221, P=0.005) and blood eosinophilic percentage (ρ=0.399, P<0.001). There was no relationship between FeNO and blood eosinophilic percentage. Blood eosinophilic percentage was predictive of sputum eosinophilia (95% confidence interval [CI] =0.65–0.81, P<0.001) at a cutoff point of 0.65% (sensitivity =73%, specificity =61.3%). FeNO levels were predictive of sputum eosinophilia (95% CI =0.53–3,071, P=0.012) at a cutoff point of 17.5 ppb (sensitivity =65.1%, specificity =56.4%).ConclusionThe clinical relevance of this study provides evidence that inflammatory biomarkers, including sputum eosinophilic percentage, FeNO level, and blood eosinophilic percentage, can be used to positively diagnose eosinophilic COPD. The FeNO level and blood eosinophilic counts/percentage, which determine an optimal cutoff for sputum eosinophilia, need more studies.

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“…A recent study of 200 COPD patients showed that 8% had an intermediate level FeNO of 25–50 parts per billion (ppb) and 3% had a high FeNO of >50 ppb 23. Interestingly, intermediate and high FeNO levels were more common in patients with features of asthma/COPD overlap 23…”

Section: Conclusion and Recommendationsmentioning

confidence: 99%

Maintenance therapy in COPD: time to phase out ICS and switch to the new LAMA/LABA inhalers?

Tariq¹,

Thomas²

2017

COPD

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Long-term maintenance therapy for COPD is evolving rapidly. Dual bronchodilation with new long-acting muscarinic antagonist and long-acting beta-agonist (LAMA/LABA) fixed dose combination inhalers were introduced over the past 2 years. In clinical trials, these inhalers significantly improved lung function (trough forced expiratory volume in 1 second), patient-reported outcomes, and quality of life measures compared with placebo, their respective monocomponents, and tiotropium. The recorded adverse events of these new inhalers were also similar to those of their monocomponents or placebo. There are concerns regarding long-term complications (weight gain, osteoporosis, cataract) and increased risk of community-acquired pneumonia with the use of inhaled corticosteroids (ICS). The new LAMA/LABA inhalers could potentially reduce the use of ICS as part and parcel of maintenance therapy in COPD. Recent studies compared these LAMA/LABA inhalers with ICS/LABA combination inhalers in moderate-to-severe COPD. The results are promising and favor the LAMA/LABA inhalers, especially in the longer duration trials. Furthermore, there is a clearer picture emerging as to the subgroup of COPD patients who may be able to successfully switch from their current ICS/LABA therapy to these new LAMA/LABA inhalers.

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Characterization of airway inflammation in patients with COPD using fractional exhaled nitric oxide levels: a pilot study

Cited by 53 publications

References 22 publications

The recent advances of phenotypes in acute exacerbations of COPD

The recent advances of phenotypes in acute exacerbations of COPD

Correlation between fractional exhaled nitric oxide and sputum eosinophilia in exacerbations of COPD

Maintenance therapy in COPD: time to phase out ICS and switch to the new LAMA/LABA inhalers?

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