Document Detail

Central and peripheral airway sites of nitric oxide gas exchange in COPD.
MedLine Citation:
PMID:  19820080     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: This study investigated sites of nitric oxide (NO) gas exchange and response to inhaled corticosteroids (ICS) in patients with COPD and varying extents of emphysema. METHODS: This was a prospective, randomized, single-blind, crossover study in treated, stable, ex-smoking patients with COPD who were ICS and leukotriene receptor antagonists naive. Lung function, high-resolution thin-section CT scan of the lung, and exhaled NO were measured at 50, 100, 150, and 200 mL/s. Airway NO was adjusted for NO axial backdiffusion. RESULTS: In 39 (18 women), clinically stable ex-smokers with COPD aged 73 +/- 9 years (mean +/- SD) on salmeterol 50 microg (S50) bid, after 180 microg aerosolized albuterol, FEV(1) (L) was 52% +/- 12% predicted and FEV(1)/FVC was 55% +/- 6%. Compared with 20 (12 men) age-matched controls, 39 patients with COPD had normal large airway NO flux and small airway/alveolar NO. Subsequently, 19 patients with COPD (Group A) were randomized and continued on S50, and 20 (Group B) were randomized to fluticasone propionate 250 microg (F250)/S50 bid for 86 +/- 16 days. Group A (S50) patients were then switched to F250/S50, and 12 of 19 completed 77 +/- 15 days; there was significant (P < .001) reduction only in the exhaled fraction of NO (FENO) at 50 mL/s and large airway NO flux. In 20 patients with COPD initially randomized to F250/S50 (Group B), after 57 +/- 22 days of S50 in 16 of 20 patients there was a significant (P = .04) increase only in (FENO) at 50 mL/s and large airway NO flux, which was not reduced after 60 +/- 23 days of fluticasone propionate 100 microg (F100)/S50(P = .07). There was no correlation between NO gas exchange and CT-scored emphysema. CONCLUSIONS: In COPD, there was normal NO gas exchange in both large and small airways/alveoli and only large airway NO flux was suppressed with F250/S50 but not F100/S50, despite varying extents of emphysema. Peripheral NO must be corrected for axial NO backdiffusion to avoid spurious conclusions. TRIAL REGISTRATION: NCT #00568347.
Arthur F Gelb; Colleen Flynn Taylor; Anita Krishnan; Christine Fraser; Chris M Shinar; Mark J Schein; Kathryn Osann
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2009-10-09
Journal Detail:
Title:  Chest     Volume:  137     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-05     Completed Date:  2010-04-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  575-84     Citation Subset:  AIM; IM    
Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, Lakewood, CA, USA.
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MeSH Terms
Administration, Inhalation
Cross-Over Studies
Drug Therapy, Combination
Exhalation / physiology*
Follow-Up Studies
Forced Expiratory Volume
Glucocorticoids / administration & dosage*
Leukotriene Antagonists / administration & dosage*
Nitric Oxide / metabolism*
Prospective Studies
Pulmonary Disease, Chronic Obstructive / drug therapy,  metabolism*,  physiopathology
Pulmonary Gas Exchange / physiology*
Single-Blind Method
Vital Capacity
Reg. No./Substance:
0/Glucocorticoids; 0/Leukotriene Antagonists; 10102-43-9/Nitric Oxide

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