Investigating Fractional Exhaled Nitric Oxide in Chronic Obstructive Pulmonary Disease (COPD) and Asthma-COPD Overlap (ACO): A Scoping Review

Mostafavi-Pour-Manshadi, Seyed Mohammad Yousof; Naderi, Nafiseh; Barrecheguren, Miriam; Dehghan, Abolfazl; Bourbeau, Jean

doi:10.1080/15412555.2018.1485637

Cited by 17 publications

(11 citation statements)

References 70 publications

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“…Fractional exhaled nitric oxide (FeNO), a reliable marker of airway inflammation in asthma, is considered to be a promising diagnostic tool for ACO. 17 , 18 In countries such as Japan, where CT is widely used and FeNO measuring devices are clinically applied in more than 2000 facilities, the preferred ACO diagnostic criteria are those that emphasize objective indicators including CT imaging, DLCO and FeNO as shown in Table 2 . 19 , 20 Due to the differences in medical resources, country-specific adaptations of the global definition may be required.…”

Section: Definition Of Acomentioning

confidence: 99%

Update on Asthma–COPD Overlap (ACO): A Narrative Review

Mekov¹,

Núñez²,

Sin³

et al. 2021

COPD

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Although chronic obstructive pulmonary disease (COPD) and asthma are well-characterized diseases, they can coexist in a given patient. The term asthma–COPD overlap (ACO) was introduced to describe patients that have clinical features of both diseases and may represent around 25% of COPD patients and around 20% of asthma patients. Despite the increasing interest in ACO, there are still substantial controversies regarding its definition and its position within clinical guidelines for patients with obstructive lung disease. In general, most definitions indicate that ACO patients must present with non-reversible airflow limitation, significant exposure to smoking or other noxious particles or gases, together with features of asthma. In patients with a primary diagnosis of COPD, the identification of ACO has therapeutic implication because the asthmatic component should be treated with inhaled corticosteroids and some studies suggest that the most severe patients may respond to biological agents indicated for severe asthma. This manuscript aims to summarize the current state-of-the-art of ACO. The definitions, prevalence, and clinical manifestations will be reviewed and some innovative aspects, such as genetics, epigenetics, and biomarkers will be addressed. Lastly, the management and prognosis will be outlined as well as the position of ACO in the COPD and asthma guidelines.

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Section: Definition Of Acomentioning

confidence: 99%

Update on Asthma–COPD Overlap (ACO): A Narrative Review

Mekov¹,

Núñez²,

Sin³

et al. 2021

COPD

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“…A high F E NO of more than 50 ppb, measured at an exhalation flow of 50 mL/s (F E NO 50 ) [6,7], can be used to indicate the possible presence of type-2 inflammation in symptomatic asthmatic patients and the likely location of the response to inhaled corticosteroids (ICS) [8]. The clinical use of F E NO in stable COPD patients is unclear as summarised by a recent scoping review [9]. Finding a relevant F E NO cut-off level for determining the use of ICS in COPD is challenging since many studies have not reported on the smoking status, which lowers F E NO levels in both the general population and the asthma and COPD population [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Different Relationships between F_ENO and COPD Characteristics in Smokers and Ex-Smokers

Högman

Thornadtsson

Bröms

et al. 2019

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Exhaled nitric oxide (F E NO) is a marker of type-2 inflammation in asthma and is used in its management. However, smokers and ex-smokers have lower F E NO values, and the clinical use of F E NO values in COPD patients is unclear. Therefore, we investigated if F E NO had a relationship to different COPD characteristics in smoking and ex-smoking subjects. Patients with COPD (n ¼ 533, 58% females) were investigated while in stable condition. Measurements of F E NO 50 , blood cell counts, IgE sensitisation and lung function were performed. Medication reconciliation was used to establish medication usage. Smokers (n ¼ 150) had lower F E NO 50 9 (8, 10) ppb (geometric mean, 95% confidence interval) than ex-smokers did (n ¼ 383) 15 (14, 16) ppb, p < 0.001. F E NO 50 was not associated with blood eosinophil or neutrophil levels in smokers, but in ex-smokers significant associations were found (r ¼ 0.23, p < 0.001) and (r ¼ -0.18, p ¼ 0.001), respectively. Lower F E NO values were associated with lower FEV 1 % predicted in both smokers (r ¼ 0.17, p ¼ 0.040) and ex-smokers (r ¼ 0.20, p < 0.001). Neither the smokers nor ex-smokers with reported asthma or IgE sensitisation were linked to an increase in F E NO 50 . Ex-smokers treated with inhaled corticosteroids (ICS) had lower F E NO 50 14 (13, 15) ppb than non-treated ex-smokers 17 (15, 19) ppb, p ¼ 0.024. This was not found in smokers (p ¼ 0.325). F E NO is associated with eosinophil inflammation and the use of ICS in ex-smoking COPD subjects, but not in smoking subjects suggesting that the value of F E NO as an inflammatory marker is more limited in smoking subjects. The association found between low F E NO values and low lung function requires further investigation.

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“…Moreover, a recent double-blind randomized placebo-controlled trial including 214 undiagnosed subjects who had cough, wheeze or dyspnea showed that FeNO could be used in clinical practice for patients with non-specific respiratory symptoms in order to predict the ICS response [ 80 ]. Although these studies showed promise for the general use of FeNO in the clinical setting of COPD, it is still unclear whether a FeNO cut-off value could be determined to identify an ICS-responsive subset of COPD patients [ 81 ]. This question is of particular importance because the GOLD guideline limited the use of ICS to only the following types of patients: (i) Group D patients with greater than 300 cells/μL of blood eosinophils in initial pharmacological treatment or in follow-up pharmacological management post exacerbations and (ii) patients with more than 100 cells/μL of blood eosinophils when experiencing more than 2 moderate exacerbations per year or at least one severe exacerbation requiring hospitalization in the prior year [ 11 ].…”

Section: Resultsmentioning

confidence: 99%

ACO (Asthma–COPD Overlap) Is Independent from COPD, a Case in Favor: A Systematic Review

Fujino

Sugiura

2021

Diagnostics

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Asthma and chronic obstructive pulmonary disease (COPD) are now recognized to be able to co-exist as asthma–COPD overlap (ACO). It is clinically relevant to evaluate whether patients with COPD concurrently have components of asthma in primary care. This is because: (i) ACO is a relatively common condition among asthma (over 40 years of age) or COPD irrespective of its diagnosis criteria; (ii) patients with ACO can have higher frequency of exacerbation and more rapid decline in lung function than those with asthma or COPD; and (iii) asthmatic features such as eosinophilic airway inflammation are promising indicators for prediction of inhaled corticosteroid-responsiveness in COPD. The aim of this review to evaluate diagnostic markers for ACO. We searched PubMed for articles related to ACO published until 2020. Articles associated with diagnostic biomarkers were included. We identified a total of 25 studies, some of which have revealed that a combination of biomarkers such as fractional exhaled nitric oxide and serum immunoglobulin E is useful to discern type 2 inflammation in the airways of COPD. Here, we review the current understanding of the clinical characteristics, biomarkers and molecular pathophysiology of ACO in the context of how ACO can be differentiated from COPD.

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Investigating Fractional Exhaled Nitric Oxide in Chronic Obstructive Pulmonary Disease (COPD) and Asthma-COPD Overlap (ACO): A Scoping Review

Cited by 17 publications

References 70 publications

Update on Asthma–COPD Overlap (ACO): A Narrative Review

Update on Asthma–COPD Overlap (ACO): A Narrative Review

Different Relationships between F_ENO and COPD Characteristics in Smokers and Ex-Smokers

ACO (Asthma–COPD Overlap) Is Independent from COPD, a Case in Favor: A Systematic Review

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Investigating Fractional Exhaled Nitric Oxide in Chronic Obstructive Pulmonary Disease (COPD) and Asthma-COPD Overlap (ACO): A Scoping Review

Cited by 17 publications

References 70 publications

Update on Asthma–COPD Overlap (ACO): A Narrative Review

Update on Asthma–COPD Overlap (ACO): A Narrative Review

Different Relationships between FENO and COPD Characteristics in Smokers and Ex-Smokers

ACO (Asthma–COPD Overlap) Is Independent from COPD, a Case in Favor: A Systematic Review

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Product

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Different Relationships between F_ENO and COPD Characteristics in Smokers and Ex-Smokers