| Central and peripheral airway sites of nitric oxide gas exchange in COPD. | |
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MedLine Citation:
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PMID: 19820080 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Arthur F Gelb; Colleen Flynn Taylor; Anita Krishnan; Christine Fraser; Chris M Shinar; Mark J Schein; Kathryn Osann |
Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial Date: 2009-10-09 |
Journal Detail:
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Title: Chest Volume: 137 ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-03-05 Completed Date: 2010-04-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: 575-84 Citation Subset: AIM; IM |
Affiliation:
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Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, Lakewood, CA, USA. afgelb@msn.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Inhalation Aged Cross-Over Studies Drug Therapy, Combination Exhalation / physiology* Female Follow-Up Studies Forced Expiratory Volume Glucocorticoids / administration & dosage* Humans Leukotriene Antagonists / administration & dosage* Male Nitric Oxide / metabolism* Prognosis Prospective Studies Pulmonary Disease, Chronic Obstructive / drug therapy, metabolism*, physiopathology Pulmonary Gas Exchange / physiology* Single-Blind Method Vital Capacity |
| Chemical | |
Reg. No./Substance:
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0/Glucocorticoids; 0/Leukotriene Antagonists; 10102-43-9/Nitric Oxide |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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