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Obstructive Lung Diseases |

Relationship of Fractional Exhaled Nitric Oxide Levels (FeNO) to GOLD Classification and Underlying Disease Classification in COPD

James Donohue, MD; Nancy Herje, MBA; Kathy Rickard, MD; Paul Dorinsky, MD
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University of North Carolina at Chapel Hill, Chapel Hill, NC


Chest. 2013;144(4_MeetingAbstracts):719A. doi:10.1378/chest.1690227
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Abstract

SESSION TITLE: COPD Severity Metrics

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 03:00 PM - 04:00 PM

PURPOSE: The purpose of this study was to characterize whether levels of Th2 airway inflammation as assessed by FeNO were related to GOLD severity or disease classification (mixed asthma/COPD, emphysema or COPD without asthma or emphysema) in patients with COPD using fractional exhaled nitric oxide (FeNO).

METHODS: This single-visit, outpatient study was conducted in 191 subjects age 40 years and older with COPD. All subjects performed spirometry and FeNO testing. COPD severity was classified according to the GOLD guidelines. Underlying disease was classified as mixed asthma/COPD, emphysema, or COPD without asthma or emphysema by evaluating ICD-9 codes from patient records.

RESULTS: The subjects who participated in the study had a mean age of 65.93 ± 11.3 years and a mean smoking history of 46 ± 29 pack years. The subjects also had a mean FEV1 % predicted of 53.9 ± 22.1%. COPD severity was classified as Stage1 in 12.6%, Stage 2 in 40.3%, Stage 3 in 38.7% and Stage 4 in 8.4% with corresponding FeNO levels of 13.7± 6.9 ppb, 18.5 ± 24.4 ppb, 13.0 ± 9.9 ppb, and 13.0 ± 8.0 ppb, respectively. FeNO levels were substantially higher in patients with mixed asthma/COPD (20.5 ± 27.6 ppb) compared with patients with emphysema (12.9 ± 8.2 ppb) or patients with COPD without a concurrent diagnosis of asthma or emphysema (12.9 ± 7.4 ppb).

CONCLUSIONS: These data indicate that increases in FeNO do occur in patients with COPD. There is, however, no obvious relationship between GOLD severity classification and FeNO level. Nonetheless, FeNO levels were substantially higher in patients with mixed asthma/COPD (20.5 ± 27.6 ppb) compared with emphysema (12.9 ± 8.2 ppb) alone or COPD without a concurrent diagnosis of asthma or emphysema (12.9 ± 7.4 ppb).

CLINICAL IMPLICATIONS: Since FeNO is useful for identifying patients with allergic airway inflammation who will have a beneficial response to treatment with a corticosteroids, these data suggest that FeNO may be also useful for identifying patients with COPD who will have a beneficial response to corticosteroids.

DISCLOSURE: James Donohue: Grant monies (from industry related sources): Recieved money to conduct the study Nancy Herje: Employee: Full time Aerocrine employee Kathy Rickard: Employee: Full time Aerocrine employee Paul Dorinsky: Employee: Full time Aerocrine Employee

No Product/Research Disclosure Information


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