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Exhaled Nitric Oxide in Patients with Stable Chronic Obstructive Pulmonary Disease: Clinical Implications of the Use of Inhaled Corticosteroids

Tuberculosis and Respiratory Diseases 2020년 83권 1호 p.42 ~ 50
조용숙 ( Jo Yong-Suk ) - Hallym University Kangdong Sacred Heart Hospital Department of Internal Medicine

 ( Choe Jun-Su ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
신선혜 ( Shin Sun-Hye ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
 ( Koo Hyeon-Kyoung ) - Inje University College of Medicine Ilsan Paik Hospital Department of Internal Medicine
리원연 ( Lee Won-Yeon ) - Yonsei University Wonju College of Medicine Wonju Severance Christian Hospital Department of Internal Medicine
김유일 ( Kim Yu-Il ) - Chonnam National University Hospital Department of Internal Medicine
나승원 ( Ra Seung-Won ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Internal Medicine
김순종 ( Yoo Kwang-Ha ) - Konkuk University School of Medicine Department of Internal Medicine
정기석 ( Jung Ki-Suck ) - Hallym University Sacred Heart Hospital Department of Internal Medicine
박혜윤 ( Park Hye-Yun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
박용범 ( Park Yong-Bum ) - Hallym University Kangdong Sacred Heart Hospital Department of Internal Medicine

Abstract


Background: Fractional exhaled nitric oxide (FeNO) is regarded as a potential biomarker for identifying eosinophilic inflammation. We aimed to evaluate the clinical implication of FeNO and its influence on inhaled corticosteroids (ICS) prescription rate in Korean chronic obstructive pulmonary disease (COPD) patients.

Methods: FeNO level and its association with clinical features were analyzed. Changes in the prescription rate of ICS before and after FeNO measurement were identified.

Results: A total of 160 COPD patients were divided into increased (≥25 parts per billion [ppb], n=74) and normal (<25 ppb, n=86) FeNO groups according to the recommendations from the American Thoracic Society. Compared with the normal FeNO group, the adjusted odds ratio for having history of asthma without wheezing and with wheezing in the increased FeNO group were 2.96 (95% confidence interval [CI], 1.40?6.29) and 4.24 (95% CI, 1.37?13.08), respectively. Only 21 out of 74 patients (28.4%) with increased FeNO prescribed ICS-containing inhaler and 18 of 86 patients (20.9%) with normal FeNO were given ICS-containing inhaler. Previous exacerbation, asthma, and wheezing were the major factors to maintain ICS at normal FeNO level and not to initiate ICS at increased FeNO level.

Conclusion: Increased FeNO was associated with the history of asthma irrespective of wheezing. However, FeNO seemed to play a subsidiary role in the use of ICS-containing inhalers in real-world clinics, which was determined with prior exacerbation and clinical features suggesting Th2 inflammation.

키워드

Chronic Obstructive Pulmonary Disease; Fractional Exhaled Nitric Oxide; Inhaled Corticosteroids
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