Exhaled nitric oxide measure using multiple flows in clinically relevant subgroups of COPD
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Exhaled nitric oxide measure using multiple flows in clinically relevant subgroups of COPD. / Roberts, Nassim Bazeghi; Gerds, Thomas A; Budtz-Jørgensen, Esben; Hove, Jens; Vestbo, Jørgen.
In: Respiratory Medicine, Vol. 105, No. 9, 2011, p. 1338-1344.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Exhaled nitric oxide measure using multiple flows in clinically relevant subgroups of COPD
AU - Roberts, Nassim Bazeghi
AU - Gerds, Thomas A
AU - Budtz-Jørgensen, Esben
AU - Hove, Jens
AU - Vestbo, Jørgen
N1 - Copyright © 2011 Elsevier Ltd. All rights reserved.
PY - 2011
Y1 - 2011
N2 - 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 FEV(1) 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.
AB - 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 FEV(1) 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.
KW - Adult
KW - Aged
KW - Biological Markers
KW - Body Mass Index
KW - Breath Tests
KW - Disease Progression
KW - Exhalation
KW - Female
KW - Forced Expiratory Volume
KW - Humans
KW - Male
KW - Middle Aged
KW - Models, Theoretical
KW - Nitric Oxide
KW - Pulmonary Disease, Chronic Obstructive
KW - Pulmonary Emphysema
KW - Questionnaires
KW - Smoking
KW - Spirometry
U2 - 10.1016/j.rmed.2011.03.015
DO - 10.1016/j.rmed.2011.03.015
M3 - Journal article
C2 - 21530214
VL - 105
SP - 1338
EP - 1344
JO - Respiratory Medicine
JF - Respiratory Medicine
SN - 0954-6111
IS - 9
ER -
ID: 38310214