Third Department of Internal Medicine, School of Medicine, Wakayama Medical University Wakayama, Japan.
Front Pharmacol. 2011 Jul 18;2:36. doi: 10.3389/fphar.2011.00036. eCollection 2011.
Inhaled corticosteroids (ICS)/inhaled long-acting beta(2)-agonists (LABA) combination drugs are widely used for the long-term management of chronic obstructive pulmonary disease (COPD). However, COPD is a heterogeneous condition and treatment with ICS is associated with a higher risk of pneumonia. The identification of a specific marker for predicting the efficacy of ICS/LABA on pulmonary function would be useful in the treatment of COPD.
Fourteen COPD patients receiving tiotropium therapy participated consecutively. The relationship between the baseline exhaled nitric oxide (FE(NO)) levels as well as serum markers and changes in pulmonary function by fluticasone propionate (FP)/salmeterol (SAL) were analyzed.
FP/SAL therapy significantly improved forced vital capacity, forced expiratory volume in 1 s (FEV(1)), and the third phase slope of the single nitrogen washout curve (ΔN(2)) as well as the FE(NO) level. The baseline FE(NO) levels and positive specific IgE (atopy+) were significantly associated with airway obstructive changes assessed by FEV(1) and ΔN(2). A baseline FE(NO) level >35 ppb yielded 80.0% sensitivity and 66.7% specificity for identifying the subjects with significant improvement in FEV(1) (greater than 200 mL). An atopy+ yielded 60.0% sensitivity and 88.9% specificity for an improvement in FEV(1). When combined with FE(NO) > 35 ppb and atopy+, it showed 40% sensitivity and 100.0% specificity for FEV(1) improvement. Alternatively, COPD subjects with FE(NO) ≤ 35 ppb and atopy- did not show significant improvement in FEV(1).
Combining FE(NO) and specific IgE may be a useful marker for predicting the response to ICS/LABA on airflow limitation in COPD.
吸入性皮质类固醇（ICS）/长效β2 激动剂（LABA）联合药物广泛用于慢性阻塞性肺疾病（COPD）的长期管理。然而，COPD 是一种异质性疾病，ICS 治疗与肺炎风险增加相关。识别一种特定的标志物来预测 ICS/LABA 对肺功能的疗效将有助于 COPD 的治疗。
连续纳入 14 例接受噻托溴铵治疗的 COPD 患者。分析了基线呼气一氧化氮（FE（NO））水平以及血清标志物与丙酸氟替卡松（FP）/沙美特罗（SAL）治疗后肺功能变化之间的关系。
FP/SAL 治疗显著改善了用力肺活量、1 秒用力呼气量（FEV1）和单氮洗脱曲线的第三相斜率（ΔN2）以及 FE（NO）水平。FE（NO）基线水平和阳性特异性 IgE（过敏）与 FEV1 和 ΔN2 评估的气道阻塞变化显著相关。FE（NO）基线水平>35 ppb 对识别 FEV1 显著改善（>200 mL）的患者具有 80.0%的敏感性和 66.7%的特异性。过敏症患者对 FEV1 的改善具有 60.0%的敏感性和 88.9%的特异性。当与 FE（NO）>35 ppb 和过敏症相结合时，对 FEV1 的改善具有 40%的敏感性和 100.0%的特异性。相反，FE（NO）≤35 ppb 和无过敏症的 COPD 患者的 FEV1 没有显著改善。
FE（NO）和特异性 IgE 的结合可能是预测 COPD 气流受限对 ICS/LABA 反应的有用标志物。
