The predictive effect of fractional exhaled nitric oxide measurement on treatment in COPD patients with different phenotype of acute exacerbation frequency_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Shuhong ,  HE Zhengguang , LUO Xiaobin , QIU Rong , ZHAO Yong , LUO Wen , LI Li , DU Fawang , LUO Li , LONG Ying , ZHAO Jie

Department of Respiratory and Critical Care Medicine, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;

Corresponding?author：

HE Zhengguang, Email: hzg997@qq.com

Keywords：

Chronic obstructive pulmonary disease; Frequent acute exacerbation phenotype; Fractional exhaled nitric oxide; Airway inflammation; Glucocorticoid

DOI：

10.7507/1671-6205.202002089

Video：

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Objective Through measuring fractional exhaled nitric oxide (FeNO) and eosinophil levels of peripheral blood in chronic obstructive pulmonary disease (COPD) patients with different phenotype of acute exacerbation frequency, to predict the therapeutic effect of glucocorticoid therapy and guide the clinical treatment of different subtypes patients with acute exacerbations of COPD.Methods A total of 127 patients with acute exacerbation of COPD in Suining Central Hospital from February 2017 to October 2019 were recruited. They were divided four groups according to the number of acute exacerbations in the past one year and the treatment scheme, ie. a frequent acute exacerbation with glucocorticoid treatment group (34 cases), a frequent acute exacerbation with non-glucocorticoid treatment group (31 cases), a non-frequent acute exacerbation with glucocorticoid treatment group (30 cases), and a non-frequent acute exacerbation with non-glucocorticoid treatment group (32 cases). FeNO value, eosinophil ratio in peripheral blood, COPD assessment test (CAT) score, and interleukin-8 (IL-8) concentration were measured before and on the 10^th day of treatment, and the differences within group and between groups before and after treatment were compared.Results CAT score, FeNO, eosinophil ratio and IL-8 level in the four groups were significantly improved on the 10^th day after treatment (all P<0.05). The declines of FeNO value, eosinophil ratio, and IL-8 level on the 10^th day of treatment compared with those before treatment in the frequent acute exacerbation with glucocorticoid treatment group and the frequent acute exacerbations with non-glucocorticoid treatment group were larger than those in the non-frequent acute exacerbation with glucocorticoid treatment group and the non-frequent acute exacerbation with non-glucocorticoid treatment group (all P<0.05). The declines of FeNO value, blood eosinophil ratio and IL-8 level in the frequent acute exacerbation with glucocorticoid treatment group were also statistically significantly larger than those in the frequent acute exacerbations with non-glucocorticoid treatment group (all P<0.05). The improvement of CAT score in the frequent acute exacerbation with glucocorticoid treatment group was greater than that in other three groups (all P<0.05). There was no significant difference in CAT score between the non-frequent acute exacerbation with glucocorticoid treatment group and the non-frequent acute exacerbation with non-glucocorticoid treatment group (P>0.05).Conclusions The degree of airway inflammation is more obvious in patients with frequent acute exacerbation phenotype of COPD. FeNO value can reflect the level of airway inflammation in patients with frequent acute exacerbation of COPD and evaluate the response to glucocorticoid therapy.

Citation： WANG Shuhong, HE Zhengguang, LUO Xiaobin, QIU Rong, ZHAO Yong, LUO Wen, LI Li, DU Fawang, LUO Li, LONG Ying, ZHAO Jie. The predictive effect of fractional exhaled nitric oxide measurement on treatment in COPD patients with different phenotype of acute exacerbation frequency. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(5): 435-440. doi: 10.7507/1671-6205.202002089 Copy

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8.	Malerba M, Radaeli A, Olivini A, et al. Exhaled nitric oxide as a biomarker in COPD and related comorbidities. Biomed Res Int, 2014, 2014: 271918.
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14.	Dweik RA, Boggs PB, Erzurum SC, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med, 2011, 184(5): 602-615.
15.	楊妍, 陳如華, 王岑, 等. 呼出氣一氧化氮水平與 COPD 患者血清 IL-6、IL-8、TNF-α 及呼吸功能的相關性. 熱帶醫學雜志, 2017, 17(1): 78-80, 84.
16.	Huang SY, Chou PC, Wang TY, et al. Exercise-induced changes in exhaled NO differentiates asthma with or without fixed airway obstruction from COPD with dynamic hyperinflation. Medicine (Baltimore), 2016, 95(15): e3400.
17.	Vedel-Krogh S, Nielsen SF, Lange P, et al. Blood eosinophils and exacerbations in chronic obstructive pulmonary disease. The Copenhagen General Population Study. Am J Respir Crit Care Med, 2016, 1932(9): 965-974.
18.	Malinovschi A, Ludviksdottir D, Tufvesson E, et al. Application of nitric oxide measurements in clinical conditions beyond asthma. Eur Clin Respir J, 2015, 2: 28517.
19.	金曉晴, 陳波, 王穎, 等. 外周血嗜酸粒細胞對重癥慢阻肺急性加重期患者療效及預后評價的研究. 武漢大學學報 (醫學版), 2017, 38(3): 475-478.
20.	Barnes NC, Sharma R, Lettis S, et al. Blood eosinophils as a marker of response to inhaled corticosteroids in COPD. Eur Respir J, 2016, 47(5): 1374-1382.
21.	費凡, 吳楨珍, 朱曼旎, 等. 血嗜酸性粒細胞在慢性阻塞性肺疾病急性加重中的臨床意義. 中國呼吸與危重監護雜志, 2019, 18(5): 418-422.

1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006, 3(11): e442.
2. Polosukhin VV, Richmond BW, Du RH, et al. Secretory IgA deficiency in individual small airways is associated with persistent inflammation and remodeling. Am J Respir Crit Care Med, 2017, 195(8): 1010-1021.
3. Barnes PJ. Cellular and molecular mechanisms of chronic obstructive pulmonary disease. Clin Chest Med, 2014, 35(1): 71-86.
4. Zhao H, Li R, Lv Y, et al. Albuterol inhalation increases FeNO level in steroid-naive asthmatics but not COPD patients with reversibility. Clin Respir J, 2017, 11(3): 328-336.
5. 王吉耀, 主編. 內科學. 第 2 版. 北京: 人民衛生出版社, 2010, 41.
6. Han MK, Agusti A, Calverley PM, et al. Chronic obstructive pulmonary disease phenotypes: the future of COPD. Am J Respir Crit Care Med, 2010, 182(5): 598-604.
7. Gastaldi AC, Paredi P, Talwar A, et al. Oscillating positive expiratory pressure on respiratory resistance in chronic obstructive pulmonary disease with a small amount of secretion: a randomized clinical trial. Medicine (Baltimore), 2015, 94(42): e1845.
8. Malerba M, Radaeli A, Olivini A, et al. Exhaled nitric oxide as a biomarker in COPD and related comorbidities. Biomed Res Int, 2014, 2014: 271918.
9. Negewo NA, McDonald VM, Baines KJ, et al. Peripheral blood eosinophils: a surrogate marker for airway eosinophilia in stable COPD. Int J Chron Obstruct Pulmon Dis, 2016, 11: 1494-1504.
10. Feng JX, Lin Y, Lin J, et al. Relationship between fractional exhaled nitric oxide level and efficacy of inhaled corticosteroid in asthma-COPD overlap syndrome patients with different disease severity. J Korean Med Sci, 2017, 32(3): 439-447.
11. Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med, 2013, 187(4): 347-365.
12. 王述紅. 慢性阻塞性肺疾病患者高分辨率 CT 表型的評價及臨床研究[D]. 昆明醫科大學, 2014.
13. Hurst JR, Vestbo J, Anzueto A, et a1. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med, 2010, 363: 1128-1138.
14. Dweik RA, Boggs PB, Erzurum SC, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med, 2011, 184(5): 602-615.
15. 楊妍, 陳如華, 王岑, 等. 呼出氣一氧化氮水平與 COPD 患者血清 IL-6、IL-8、TNF-α 及呼吸功能的相關性. 熱帶醫學雜志, 2017, 17(1): 78-80, 84.
16. Huang SY, Chou PC, Wang TY, et al. Exercise-induced changes in exhaled NO differentiates asthma with or without fixed airway obstruction from COPD with dynamic hyperinflation. Medicine (Baltimore), 2016, 95(15): e3400.
17. Vedel-Krogh S, Nielsen SF, Lange P, et al. Blood eosinophils and exacerbations in chronic obstructive pulmonary disease. The Copenhagen General Population Study. Am J Respir Crit Care Med, 2016, 1932(9): 965-974.
18. Malinovschi A, Ludviksdottir D, Tufvesson E, et al. Application of nitric oxide measurements in clinical conditions beyond asthma. Eur Clin Respir J, 2015, 2: 28517.
19. 金曉晴, 陳波, 王穎, 等. 外周血嗜酸粒細胞對重癥慢阻肺急性加重期患者療效及預后評價的研究. 武漢大學學報 (醫學版), 2017, 38(3): 475-478.
20. Barnes NC, Sharma R, Lettis S, et al. Blood eosinophils as a marker of response to inhaled corticosteroids in COPD. Eur Respir J, 2016, 47(5): 1374-1382.
21. 費凡, 吳楨珍, 朱曼旎, 等. 血嗜酸性粒細胞在慢性阻塞性肺疾病急性加重中的臨床意義. 中國呼吸與危重監護雜志, 2019, 18(5): 418-422.

Chinese Journal of Respiratory and Critical Care Medicine

The predictive effect of fractional exhaled nitric oxide measurement on treatment in COPD patients with different phenotype of acute exacerbation frequency

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