Comparison of Fractional Exhaled Nitric Oxide in Elderly Patients with Asthma-chronic Obstructive Pulmonary Disease Overlap and Other Airway Inflammatory Diseases
-
Fei Shi
,
Chen Qiu
,
Jie Yu
,
Ying Yang
,
Binbin Li
,
Mengjie Feng
,
Ting Zhang
,
Wenwen Liu
Abstract
The exact role of fractional exhaled nitric oxide (FeNO) in older patients with chronic inflammatory diseases including asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) remains unclear. This study aimed to investigate the differences in FeNO levels of elderly patients with ACO, asthma, COPD, and chronic cough. We conducted a retrospective study analysing the data of stable outpatients from Pulmonary Department of the Second Clinical College, Jinan University. All participants (Age≥55 years) were divided into the ACO group (n=19), asthma group (n=16), COPD group (n=25), and chronic cough group (n=22). The clinical data such as peripheral eosinophil counts, serum high sensitivity C-reactive protein (hs-CRP), FeNO, and spirometry was collected, and the correlations between FeNO levels and systemic markers or spirometric indices were analyzed. Patients with ACO and asthma had significantly elevated FeNO levels (37.7±16.5, and 36.3±17.7 ppb) compared with COPD, and chronic cough patients (21.9±10.3, and 16.1±8.8 ppb). The FeNO levels were negatively associated with forced expiratory volume in 1 second (FEV1, p=0.003), FEV1% predicted (p=0.012), and FEV1/forced vital capacity (FVC, p=0.002) in all groups. However, there were no significant correlation between FeNO levels and FVC, peripheral eosinophil counts, or serum hs-CRP (p>0.05). Elderly patients with ACO have higher levels of FeNO, when compared with patients with COPD or chronic cough. These findings suggest that FeNO measurement may provide an important implication for the etiological diagnosis of ACO in the elderly patients.
1. May SM, Li JT. Burden of chronic obstructive pulmonary disease: healthcare costs and beyond. Allergy Asthma Proc 2015; 36(1):4-10.
2. Gershon AS, Khan S, Klein-Geltink J, Wilton D, To T, Crighton EJ, et al. Asthma and chronic obstructive pulmonary disease (COPD) prevalence and health services use in Ontario Metis: a population-based cohort study. PloS one 2014; 9(4):e95899.
3. Gibson PG, Simpson JL. The overlap syndrome of asthma and COPD: what are its features and how important is it? Thorax 2009; 64(8):728-735.
4. Guerra S. Overlap of asthma and chronic obstructive pulmonary disease. Curr Opin Pulm Med 2005; 11(1):7-13.
5. Barrecheguren M, Esquinas C, Miravitlles M: The asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS): opportunities and challenges. Curr Opin Pulm Med 2015; 21(1):74-9.
6. Braman SS. The chronic obstructive pulmonary disease-asthma overlap syndrome. Allergy Asthma Proc 2015; 36(1):11-8.
7. Christenson SA, Steiling K, van den Berge M, Hijazi K, Hiemstra PS, Postma DS, et al. Asthma-COPD overlap. Clinical relevance of genomic signatures of type 2 inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2015; 191(7):758-66.
8. Angelis N, Porpodis K, Zarogoulidis P, Spyratos D, Kioumis I, Papaiwannou A, Pitsiou G, Tsakiridis K, Mpakas A, Arikas S et al: Airway inflammation in chronic obstructive pulmonary disease. J Thorac Dis 2014; 6(Suppl 1):S167-72.
9. Donohue JF, Herje N, Crater G, Rickard K. Characterization of airway inflammation in patients with COPD using fractional exhaled nitric oxide levels: a pilot study. Int J Chron Obstruct Pulmon Dis 2014; 9:745-51.
10. Schneider A, Schwarzbach J, Faderl B, Welker L, Karsch-Volk M, Jorres RA. FENO measurement and sputum analysis for diagnosing asthma in clinical practice. Respir Med 2013; 107(2):209-16.
11. American Thoracic Society; European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med 2005; 171(8):912-30.
12. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005; 26(2):319-38.
13. Malinovschi A, Fonseca JA, Jacinto T, Alving K, Janson C. Exhaled nitric oxide levels and blood eosinophil counts independently associate with wheeze and asthma events in National Health and Nutrition Examination Survey subjects. J Allergy Clin Immunol 2013; 132(4):821-27.
14. Maniscalco M, Faraone S, Sofia M, Molino A, Vatrella A, Zedda A. Extended analysis of exhaled and nasal nitric oxide for the evaluation of chronic cough. Respir Med 2015; 109(8):970-4.
15. Alvarez-Puebla MJ, Olaguibel Rivera JM, Almudevar E, Echegoyen AA, de Esteban Chocarro B, Cambra K. Cutoff point for exhaled nitric oxide corresponding to 3% sputum eosinophils. J Investig Allergol Clin Immunol 2015; 25(2):107-11.
16. Korevaar DA, Westerhof GA, Wang J, Cohen JF, Spijker R, Sterk PJ, et al. Diagnostic accuracy of minimally invasive markers for detection of airway eosinophilia in asthma: a systematic review and meta-analysis. Lancet Respir Med 2015; 3(4):290-300.
17. Ketai L, Harkins M, Fiato KL, Iwamoto GK. Exhaled nitric oxide and bronchial wall thickening in asthmatics during and after acute exacerbation: evidence of bronchial wall remodeling. J Asthma 2005; 42(8):667-71.
18. Gagliardo R, La Grutta S, Chanez P, Profita M, Paterno A, Cibella F, et al. Non-invasive markers of airway inflammation and remodeling in childhood asthma. Pediatr Allergy Immunol 2009; 20(8):780-90.
19. Ricciardolo FL, Sorbello V, Ciprandi G. A pathophysiological approach for FeNO: A biomarker for asthma. Allergol Immunopathol (Madr) 2015; 43(6):609-16.
20. Park JY, Lee T, Lee H, Lee YJ, Park JS, Cho YJ, et al. Significance of fractional exhaled nitric oxide in chronic eosinophilic pneumonia: a retrospective cohort study. BMC Pulm Med 2014; 14:81.
21. Ferrante G, Malizia V, Antona R, Corsello G, La Grutta S. The value of FeNO measurement in childhood asthma: uncertainties and perspectives. Multidiscip Respir Med 2013; 8(1):50.
22. Ricciardolo FL, Di Stefano A, Silvestri M, Van Schadewijk AM, Malerba M, Hiemstra PS, et al. Exhaled nitric oxide is related to bronchial eosinophilia and airway hyperresponsiveness to bradykinin in allergen-induced asthma exacerbation. Int J Immunopathol Pharmacol 2012; 25(1):175-82.
23. Price D, Ryan D, Burden A, Von Ziegenweidt J, Gould S, Freeman D, et al. Using fractional exhaled nitric oxide (FeNO) to diagnose steroid-responsive disease and guide asthma management in routine care. Clin Transl Allergy 2013; 3(1):37.
24. Rouatbi S, Chouchene MA, Sfaxi I, Ben Rejeb M, Tabka Z, Ben Saad H. Fraction of exhaled nitric oxide (FeNO ) norms in healthy Tunisian adults. Biomed Res Int 2014; 2014:269670.
25. Ichinose M, Takahashi T, Sugiura H, Endoh N, Miura M, Mashito Y, Shirato K. Baseline airway hyperresponsiveness and its reversible component: role of airway inflammation and airway calibre. Eur Respir J 2000, 15(2):248-53.
26. Fujisawa T, Yasui H, Akamatsu T, Hashimoto D, Enomoto N, Inui N, et al. Alveolar nitric oxide concentration reflects peripheral airway obstruction in stable asthma. Respirology 2013; 18(3):522-7.
27. Zhang H, Shu L, Cai X, Wang Z, Jiao X, Liu F, et al. Gender and age affect the levels of exhaled nitric oxide in healthy children. Exp Ther Med 2013; 5(4):1174-8.
| Files | ||
| Issue | Vol 17, No 3 (2018) | |
| Section | Original Article(s) | |
| Keywords | ||
| Asthma-chronic obstructive pulmonary disease overlap Asthma Elderly Nitric oxide | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
