0
Original Research: COPD |

Central and Peripheral Airway Sites of Nitric Oxide Gas Exchange in COPD

Arthur F. Gelb, MD, FCCP; Colleen Flynn Taylor, MA; Anita Krishnan, MD; Christine Fraser, RCP, CPFT; Chris M. Shinar, PharmD; Mark J. Schein, MD; Kathryn Osann, PhD
Author and Funding Information

From the Pulmonary Division, Department of Medicine (Dr Gelb) and Department of Radiology (Dr Schein), Lakewood Regional Medical Center, Lakewood, CA; Geffen School of Medicine (Dr Gelb); University of California at Los Angeles, CA; the Department of Performance Improvement and Patient Safety (Dr Shinar), Orange Coast Memorial Medical Center, Fountain Valley, CA; and Department of Medicine, School of Medicine (Dr Osann), University of California at Irvine, CA. Ms Taylor, Dr Krishnan, and Ms Fraser are independent research contractors.

Correspondence to: Arthur F. Gelb, MD, 3650 E South St. Ste 308, Lakewood, CA 90712; e-mail: afgelb@msn.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(3):575-584. doi:10.1378/chest.09-1522
Text Size: A A A
Published online

Background:  This study investigated sites of nitric oxide (NO) gas exchange and response to inhaled corticosteroids (ICS) in patients with COPD and varying extents of emphysema.

Methods:  This was a prospective, randomized, single-blind, crossover study in treated, stable, ex-smoking patients with COPD who were ICS and leukotriene receptor antagonists naive. Lung function, high-resolution thin-section CT scan of the lung, and exhaled NO were measured at 50, 100, 150, and 200 mL/s. Airway NO was adjusted for NO axial backdiffusion.

Results:  In 39 (18 women), clinically stable ex-smokers with COPD aged 73 ± 9 years (mean ± SD) on salmeterol 50 μg (S50) bid, after 180 μg aerosolized albuterol, FEV1 (L) was 52% ± 12% predicted and FEV1/FVC was 55% ± 6%. Compared with 20 (12 men) age-matched controls, 39 patients with COPD had normal large airway NO flux and small airway/alveolar NO. Subsequently, 19 patients with COPD (Group A) were randomized and continued on S50, and 20 (Group B) were randomized to fluticasone propionate 250 μg (F250)/S50 bid for 86 ± 16 days. Group A (S50) patients were then switched to F250/S50, and 12 of 19 completed 77 ± 15 days; there was significant (P < .001) reduction only in the exhaled fraction of NO (FENO) at 50 mL/s and large airway NO flux. In 20 patients with COPD initially randomized to F250/S50 (Group B), after 57 ± 22 days of S50 in 16 of 20 patients there was a significant (P = .04) increase only in (FENO) at 50 mL/s and large airway NO flux, which was not reduced after 60 ± 23 days of fluticasone propionate 100 μg (F100)/S50(P = .07). There was no correlation between NO gas exchange and CT-scored emphysema.

Conclusions:  In COPD, there was normal NO gas exchange in both large and small airways/alveoli and only large airway NO flux was suppressed with F250/S50 but not F100/S50, despite varying extents of emphysema. Peripheral NO must be corrected for axial NO backdiffusion to avoid spurious conclusions.

Trial registration:  NCT #00568347.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543