Exhaled nitric oxide measure using multiple flows in clinically relevant subgroups of COPD

Jorgen Vestbo, Nassim Bazeghi, Thomas A. Gerds, Esben Budtz-Jørgensen, Jens Hove, Jørgen Vestbo

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Although there is widespread interest in fractional exhaled nitric oxide (FeNO) as a non-invasive, time and cost effective biomarker for assessing airway inflammation in chronic obstructive pulmonary disease (COPD), its usefulness is still controversial. We examined the FeNO levels in clinically meaningful subgroups of COPD in a group of 91 COPD patients with FEV1 17-77% of predicted. Multiple flow rates FeNO at 10, 30, 50, 100 and 200 mL/s were measured and a two-compartment model was used to estimate the diffusion Capacity (D), alveolar NO concentration (Calv) and airway wall NO concentration (Caw). All patients had spirometry, assessment of symptoms with questionnaires and low-dose CT scan as well as assessment of weight and body composition. We examined the following subgroups of COPD: Patients with 1) Severe emphysema, 2) Chronic bronchitis, 3) Frequent exacerbations, 4) Loss of lean body mass and 5) Low fat-free mass index. We used advanced non-linear mixed model adjusted for age and gender. The modelled differences in D, Calv or Caw among COPD subgroups were small and not statistically significant. The analysis showed significant effects of current smoking on Caw and of gender on D and Calv. The results were the same if the advanced non-linear mixed model was substituted by more standard analysis techniques. This study questions the relevance of using FeNO as a biomarker to evaluate local inflammation in COPD and points to a need for developing novel non-invasive biomarkers for research laboratory work and daily clinical practice. © 2011 Elsevier Ltd. All rights reserved.
    Original languageEnglish
    Pages (from-to)1338-1344
    Number of pages6
    JournalRespiratory Medicine
    Volume105
    Issue number9
    DOIs
    Publication statusPublished - Sept 2011

    Keywords

    • Biomarker
    • Chronic bronchitis
    • COPD
    • Emphysema
    • Exacerbations
    • Nitric oxide

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