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Predicting corticosteroid response in chronic obstructive pulmonary disease using exhaled nitric oxide
Jack F Dummer1, Michael J Epton, Jan O Cowan
1Dunedin and Christchurch Schools of Medicine, University of Otago, Dunedin, New Zealand.
American Journal of Respiratory and Critical Care Medicine
|August 8, 2009
Summary
Fraction of exhaled nitric oxide (Fe(NO)) is a weak predictor of oral corticosteroid response in COPD, primarily limited to predicting FEV1 increases. This finding is crucial for tailoring COPD treatment strategies.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Trials
Background:
- Predicting corticosteroid response in Chronic Obstructive Pulmonary Disease (COPD) is challenging.
- Eosinophilic airway inflammation, a predictor of response, can be assessed using fraction of exhaled nitric oxide (Fe(NO)).
Purpose of the Study:
- To determine if Fe(NO) levels can predict clinical response to oral corticosteroids in COPD patients.
Main Methods:
- A double-blind, crossover trial involving 65 COPD patients.
- Patients received oral prednisone or placebo after a washout period.
- Evaluated Fe(NO) predictive values for changes in 6-minute-walk distance (6MWD), spirometry (FEV1), and St. George's Respiratory Questionnaire (SGRQ).
Main Results:
- Prednisone significantly increased 6MWD and FEV1 compared to placebo.
- Fe(NO) was a weak predictor of overall short-term response.
- An Fe(NO) cut-point of 50 ppb showed moderate predictive value for FEV1 increase (AUC 0.69, P=0.04).
Conclusions:
- Fe(NO) has limited utility in predicting short-term oral corticosteroid response in COPD.
- Its usefulness is primarily confined to predicting improvements in FEV1.
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