Fractional Exhaled Nitric Oxide as an Inflammatory Biomarker in Chronic Obstructive Pulmonary Disease (COPD) with or without Concurrent Diagnosis of Asthma: The Canadian Cohort Obstructive Lung Disease (CanCOLD)
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2020
Posted: 17 Jul 2020
Date Written: June 25, 2020
Abstract
We studied whether fractional exhaled nitric oxide (FENO) can differentiate chronic obstructive pulmonary disease (COPD) with concurrent diagnosis of asthma from COPD-only as well as its ability to predict disease severity and progression.
This study was embedded in the Canadian Cohort Obstructive Lung Disease (CanCOLD).
Subjects of ≥40 years old completed FENO measurements were subdivided into four groups, including COPD (N=86 [COPD-only (N=35) and COPD with concurrent diagnosis of asthma (N=51)], healthy (N=72), and at risk (N=151). Three of the most common clinical definitions were used for characterizing COPD with concurrent diagnosis of asthma: 1) atopy and self-reported physician diagnosis of asthma, 2) ≥12% and ≥200 ml post-bronchodilator FEV1; 3) self-reported physician diagnosis of asthma. FENO values were classified using quartiles and the American Thoracic Society (ATS) guideline 2011.
Compared to COPD-only, more COPD with concurrent diagnosis of asthma had a significant FENO50 ≥ 33.5 ppb (fourth quartile) than COPD-only (p=0.045, 0.011, and 0.006, for definition 1, 2, and 3, respectively). Considering the ATS guideline 2011, fewer COPD with concurrent diagnosis of asthma had FENO50 < 25 than COPD-only, which was statistically significant with definition 1 and 3 (p=0.038 and 0.026, respectively).
FENO as a biomarker has the potential to be used as a complementary value for differentiating COPD with concurrent diagnosis of asthma from COPD-only. Further studies should be conducted on validated definitions of COPD with concurrent diagnosis of asthma, which may include a reference to the type of airway inflammation in addition to the clinical definition.
Keywords: Fractional Exhaled Nitric Oxide, Chronic Obstructive Pulmonary Disease, COPD, Asthma, Canadian Cohort Obstructive Lung Disease, CanCOLD
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