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Fractional Exhaled Nitric Oxide in Eosinophilic COPD
Pablo E Morejon-Jaramillo1, Wenli Ni1,2, Nicholas Nassikas1
1Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States.
Chronic Obstructive Pulmonary Diseases (Miami, Fla.)
|November 10, 2025
Summary
Fractional exhaled nitric oxide (FeNO) can identify type 2 inflammation in eosinophilic chronic obstructive pulmonary disease (COPD). Higher FeNO levels correlate with blood eosinophil counts and asthma history, potentially predicting severe COPD exacerbations.
Area of Science:
- Pulmonology
- Biomarkers
- Respiratory Medicine
Background:
- Eosinophilic chronic obstructive pulmonary disease (COPD) is a distinct subtype with unique clinical and biological characteristics.
- Fractional exhaled nitric oxide (FeNO) is a known marker for type 2 airway inflammation in asthma, but its role in eosinophilic COPD is not well-established.
Purpose of the Study:
- To investigate the utility of FeNO as a biomarker for type 2 inflammation in eosinophilic COPD.
- To explore the association between FeNO, blood eosinophil counts, asthma history, and severe exacerbations in eosinophilic COPD patients.
Main Methods:
- Analysis of baseline data from 176 former smokers with eosinophilic COPD enrolled in a randomized controlled trial.
- Measurement of FeNO and blood eosinophil counts at enrollment.
- Collection of data on asthma history and severe COPD exacerbations requiring hospitalization in the prior year.
Main Results:
- A higher blood eosinophil count was associated with increased FeNO levels.
- A history of asthma was significantly associated with higher FeNO.
- Elevated FeNO levels showed a trend towards association with a higher likelihood of asthma diagnosis and recent severe exacerbations.
Conclusions:
- FeNO may serve as a practical, noninvasive biomarker for type 2 inflammation in eosinophilic COPD.
- FeNO could potentially help identify patients with eosinophilic COPD who are at higher risk for severe exacerbations.
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