Fractional exhaled nitric oxide detection in treatment of asthma-chronic obstructive pulmonary disease overlap syndrome / 第二军医大学学报

ABSTRACT

Objective To investigate the value of fractional exhaled nitric oxide (FeNO) in the treatment of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). Methods The twenty-eight ACOS patients receiving no standardmedication treatment were recruited from May 2015 to Oct. 2015 in Suzhou Kowloon Hospital; the patients inhaled corticosteroids/long-acting beta agonist (ICS/LABA) for 12 weeks and the changes of FeNO levels, FEV1%pred, induced sputum eosinophil (EOS), blood total IgE, and high sensitivity C-reactive protein (hs-CRP) were examined before and after treatment. The correlations between FeNO and other indices were analyzedby Pearson correlation coefficient method. The patients were divided into different groups according to different age and smoking statuses, and the changes of the indices before and after treatment were compared between different groups. Twenty-eight healthy participants were recruited as control group and their FeNO levels were also tested. Results After treatment, the FeNO levels ([32. 04±8. 34] × 10-9 mol/L vs [25. 56 ±13] ×10-9 mol/L, P<0. 05), induced sputum EOS ([18. 51 ± 5. 36]% vs [13. 18 ± 1. 56]%, P<0. 05), and blood total IgE ([251. 91 ± 42. 24] ng/mL vs [204. 65 ± 28. 52] ng/mL, P<0. 05) of ACOS patients were significantly lower than those before treatment. There was no significant difference in FEV1%pred ([52. 03 ± 7. 03-% vs [55. 16 ± 8. 20-%, P = 0. 391) or hs-CRP ([10. 86 ± 4. 92- mg/L vs [9. 16 ± 1. 82) mg/L, P = 0. 077) before and after treatment in ACOS patients. Meanwhile, the levels of FeNO in ACOS group were significantly higher than those in the healthy control group before and after treatment ([32. 04±8. 34-×10-9 mol/L, [25. 56 ± 4. 13×10-9 mol/L vs [17. 04+0. 97×10-9 mol/L,P<0. 05). The levels of FeNO, induced sputum EOS and serum total IgE were significantly different among different ages and smoking status before and after ICS/LABA treatment. The pre- and post-treatment FeNO levels were positively correlated with induced sputum EOS and serum total IgE (pre-treatment; r=S 92S, P<0. 01 and s=S I4I, P<0. 01; sost-treatment; r=0. 247, P<0. 01 and r=0. 443, P<0. 01); while it was not correlated with serumhs-CRP or FEV1%pred. Conclusion Our findings indicate that eosinophilic inflammation is present in the airways of ACOS patients, which can be treated with ICS/LABA inhalation. The curative effect is not affected by age or smoking status. FeNO detection can be used to evaluate the efficacy of ICS/LABA for ACOS, which is associated with induced sputum EOS and serum total IgE.