Predicting Corticosteroid Response in Chronic Obstructive Pulmonary Disease Using Exhaled Nitric Oxide

Dummer, Jack; Epton, Michael; Cowan, Jan O.; Cook, Julie; Condliffe, Robin; Landhuis, C. Erik; Smith, Andrew D.; Taylor, D. Robin

doi:10.1164/rccm.200905-0685oc

Cited by 68 publications

(55 citation statements)

References 32 publications

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“…The results of the study showed that exhaled nitric oxide is a weak predictor in patients with COPD and that a normal or low test result could help clinicians decide to avoid prescriptions of oral corticosteroid treatment that may be unnecessary. This result was in agreement with other previous study [38]. These observations help us to expect that those patients with COPD would have greater systemic inflammatory marker activation and those with asthma would have more local inflammatory marker activation.…”

Section: Discussionsupporting

confidence: 93%

Fraction of exhaled nitric oxide measurement as a biomarker in asthma and COPD compared with local and systemic inflammatory markers

Rawy

Mansour

2015

Egyptian Journal of Chest Diseases and Tuberculosis

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Background: Asthma and COPD are characterized by chronic airway inflammation that results in chronic airway obstruction which is reversible in asthma and non-reversible or partially reversible in COPD. The differential diagnosis between reversible or irreversible airflow obstruction due to asthma or COPD is important in clinical practice because the prognosis and the response to treatment of the two diseases are different. Nitric oxide (NO) is produced by many cells within the respiratory tract. Endogenous NO may play an important signaling role in the physiological control of airway function and in the pathophysiology of airway diseases. Measurement of airway inflammation by means of FENO may be useful and convenient for asthma diagnosis, particularly when bronchial challenges and/or spirometric maneuvers cannot be correctly performed. The increase in the percentage of peripheral blood and sputum eosinophils was found in patients with asthma that correlated with the clinical severity of asthma and pulmonary function. Elevated levels of C-reactive protein (CRP) are established in COPD but, in asthma, the results have been inconsistent. The aim of the present study was to evaluate differences in local (airway) and systemic inflammatory markers among primary care patients with asthma and COPD using simple, rapid and easy to do tests.Subjects and methods: One hundred and fifty patients and thirty control subjects were included in this study. They were divided into three groups, ninety asthmatic patients diagnosed clinically and physiologically as reversible airway obstruction (group I). Sixty COPD patients diagnosed by clinical, physiological and laboratory tests to have irreversible or partially reversible airway obstruction (group II). The third group is the control group with no airway obstruction (NAO) including thirty subjects. Pulmonary function tests, FENO, hs-CRP, blood and sputum eosinophil percentages were done to all subjects.Results: FENO was positively correlated with all inflammatory markers in the asthmatic group with highly significant differences (p 6 .001) and negatively correlated with age, BMI and PFTs. In

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Section: Discussionsupporting

confidence: 93%

Fraction of exhaled nitric oxide measurement as a biomarker in asthma and COPD compared with local and systemic inflammatory markers

Rawy

Mansour

2015

Egyptian Journal of Chest Diseases and Tuberculosis

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“…In contrast to asthma, FeNO is less useful in predicting the short-term ICS response in stable COPD, although it predicts treatment response in acute exacerbations of COPD. Dummer et al [48] showed that whilst a raised FeNO is a weak predictor of short-term response to oral steroids in patients with stable, moderately severe COPD, a normal FeNO result has clinical utility in predicting the absence of a response. It was pointed out that in the context of treating COPD, in which at best only 20% of patients will demonstrate steroid responsiveness, this information would help the clinician avoid prescribing unnecessary ICS treatment [48].…”

Section: Cluster Analysis In Chronic Obstructive Pulmonary Diseasementioning

confidence: 99%

The multiple dimensions of airways disease: targeting treatment to clinical phenotypes

Shirtcliffe

Weatherall

Travers

et al. 2011

Current Opinion in Pulmonary Medicine

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“…Exhaled nitric oxide (FE NO ) is a surrogate of large airway inflammation and has an established role in asthma [6]. The use of FE NO as a biomarker in COPD, however, is questionable [7]. Cigarette smoking is known to suppress FENO levels in COPD patients [8], and evidence of elevation of FE NO in COPD patients is inconsistent [9,10].…”

Section: Introductionmentioning

confidence: 99%

Effects of Extra-Fine Inhaled and Oral Corticosteroids on Alveolar Nitric Oxide in COPD

Short

Williamson

Lipworth

2012

Lung

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Predicting Corticosteroid Response in Chronic Obstructive Pulmonary Disease Using Exhaled Nitric Oxide

Abstract: Fe(NO) is a weak predictor of short-term response to oral corticosteroid in COPD, its usefulness being limited to predicting increase in FEV(1). Clinical trial registered with www.anzctr.org.au (ACTRN12605000683639).

Cited by 68 publications

References 32 publications

Fraction of exhaled nitric oxide measurement as a biomarker in asthma and COPD compared with local and systemic inflammatory markers

Fraction of exhaled nitric oxide measurement as a biomarker in asthma and COPD compared with local and systemic inflammatory markers

The multiple dimensions of airways disease: targeting treatment to clinical phenotypes

Effects of Extra-Fine Inhaled and Oral Corticosteroids on Alveolar Nitric Oxide in COPD

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