Clinic of Pneumology and Pulmonary Cell Research, University Hospital, Basel, Switzerland.
Department of Pneumology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Respirology. 2023 May;28(5):445-454. doi: 10.1111/resp.14439. Epub 2022 Dec 26.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are heterogeneous in aetiology and accelerate disease progression. Here, we aimed to investigate the association of fractional exhaled nitric oxide (FeNO) and its variability with AECOPD of different aetiology.
FeNO was determined in 2157 visits (1697 stable, 133 AECOPD and 327 follow-up) of 421 COPD patients from the PREVENT study, an investigator-initiated, longitudinal and interventional study, who were on daily treatment with inhaled corticosteroids/long-acting β2-agonists.
Longitudinal measurements of FeNO revealed an intra-subject variability of FeNO that was significantly higher in exacerbators compared to non-exacerbators (p < 0.001) and positively associated with the number of AECOPD. As FeNO variability increased, the probability of patients to remain AECOPD-free decreased. In patients included in the highest FeNO variability quartile (≥15.0 ppb) the probability to remain free of AECOPD was only 35% as compared to 80% for patients included in the lowest FeNO variability quartile (0.50-4.39 ppb). The change of FeNO from the last stable visit to AECOPD was positively associated with the probability of viral infections and this association was stronger in current smokers than ex-smokers. In contrast, the change in FeNO from the last stable visit to an AECOPD visit was inversely associated with the probability of bacterial infections in ex-smokers but not in current smokers.
FeNO variability was associated with the risk and aetiology of AECOPD differentially in current and ex-smokers.
慢性阻塞性肺疾病（COPD）的急性加重（AECOPD）在病因上具有异质性，并加速疾病进展。在这里，我们旨在研究呼出气一氧化氮分数（FeNO）及其变异性与不同病因AECOPD 的相关性。
我们对来自 PREVENT 研究的 421 名 COPD 患者的 2157 次就诊（1697 次稳定，133 次 AECOPD 和 327 次随访）进行了 FeNO 测定，该研究是一项由研究者发起的、纵向和干预性研究，患者每天接受吸入皮质激素/长效β2-激动剂治疗。
FeNO 的纵向测量显示，与非加重者相比，加重者的 FeNO 个体内变异性明显更高（p<0.001），并与 AECOPD 的次数呈正相关。随着 FeNO 变异性的增加，患者保持 AECOPD 无发作的可能性降低。在 FeNO 变异性最高的四分位组（≥15.0 ppb）中，患者保持无 AECOPD 的可能性仅为 35%，而在 FeNO 变异性最低的四分位组（0.50-4.39 ppb）中为 80%。从最近一次稳定就诊到 AECOPD 就诊时 FeNO 的变化与病毒感染的可能性呈正相关，并且这种关联在当前吸烟者中比在戒烟者中更强。相比之下，从最近一次稳定就诊到 AECOPD 就诊时 FeNO 的变化与戒烟者细菌感染的可能性呈负相关，但与当前吸烟者无关。
FeNO 变异性与当前和戒烟者的 AECOPD 风险和病因呈不同相关性。
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