To Predict The Effect Of Inhaled Corticosteroid By Exhaled Nitric Oxide Of Patients With Stable Chronic Obstructive Pulmonary Disease

BackgroundChronic obstructive pulmonary disease is a common chronic respiratory disease and one of the highest morbidity and mortality disease in worldwide, and is characteristic of persistent airflow limitation and progressive development, which main symptoms are cough, sputum, chest tightness, wheezing, shortness of breath and so on. The essence of COPD is the inflammation of airway and lung tissue, which is related to inhaling cigarette and harmful particles. Alveolar macrophages, neutrophlis and CD8+ T-cells are participated in the process of inflammation of COPD. In addition,the lung alveolar epithelial cells and endothelial cells were involved in airway inflammation. In recent years, there are more studies have shown that eosinophlis and mast cells are also involved in the inflammation of airway, especially in the patients with acute chronic obstructive pulmonary diseaseFraction of exhaled nitric oxide is currently widely studied marker in airway inflammation, and plays an important role in the respiratory system inflammation and oxidative stress. In particular, it has been gradually paid attention to in the diagnosis and treatment of bronchial asthma. Domestic and abroad researches have shown that FeNO can represent the level of airway inflammation in bronchial asthma and COPD, especially in areas of eosinophil airway inflammation. Glucocorticoid treatment effect in patients with eosinophil airway inflammation is better, therefore, the clinical FeNO can guide patients with airway inflammation using glucocorticoid treatment.Chronic airway inflammation in COPD can cause damage, repair and reconstruction of airway wall, so the key to delay the progression of COPD and pulmonary function is to control airway inflammation. Glucocorticoids play the vital roles in the control of airway inflammation, and the mechanism mainly directly inhibite activation of neutrophil cells, eosinophils and alveolar macrophage, and inhibite synthesis and release of leukotriene, prostacyclin and other inflammatory mediators, to relaxing airway and improve lung function in patients. However, some studies have shown that COPD patients with glucocorticoid can increase the incidence of pneumonia, osteoporosis and other complications, therefore, there is an urgent need to be able to guide the clinical application of glucocorticoids in patients with COPD. As a useful marker of airway inflammation, FENO has simple operation, good reproducibility, high sensitivity and specificity, which can be used to guide the treatment of COPD in patients with glucocorticoid. ObjectiveTo investigate the value of fractional of exhaled nitric oxide measurement in predicting of using inhaled glucocorticoid in stable chronic obstructive pulmonary disease patients. Methods1. Selecting 31 stable COPD (patients with cough, expectoration, shortness of breath and other symptoms stable or slightly) patients from 2015 3-7 months treatment in Shandong provincial hospital respiratory clinic;2. We experimented single group, open test research. Before the research, we determinated FeNO values (expiratory flow 50mL/s) and underwent pulmonary function and bronchial diastolic test examination before sitting quietly for 10 minits, and determination of process to keep the seat.3. After the inspection confirmed COPD patients were given budesonide and formoterol powder(160ug/4.5ug) inhalation, twice daily and 1 ceiling/time, and were given the phlegm, cough and other basic treatment, at the mean time we would urge patients to stop smoking and rehabilitate exercises and other treatment. After 4 weeks,we would repeat the above examines. 4. Patients were recorded before and after treatment with FENO values and pulmonary function indicators (including FEV1, FEV1%, FVC,,FEV1/FVC%, etc.)Results31 cases of stable COPD patients, one case stopped the inhalation of drug, in that she had throat discomfort, irritating cough and other adverse drug reactions,and 30 cases of COPD patients were successfully completed the study.1. The relationship between general information of subjects, smoking,lung function grading and FeNOFeNO in different gender, age, BMI, smoking and non smoking, and lung function group had no statistical significance (P>0.05);2. The relationship between lung function index and FeNOBaseline FeNO values had no significant correlation with baseline FEV1 values (r=0.203, P=0.281). However, baseline FeNO levels have a significant correlations with the improved forced expiratory volume in one second (FEV1) after the use of ICS therapy (r=0.865, P<0.05);3. The change trend of FENO after inhaling ICSThe higher baseline FENO, the greater the declines of FENO after 4 weeks of treatment with ICS, and vice versa.4. Predictive value of baseline levels of FENO for inhaled corticosteroid therapy in patients with COPDThe baseline FENO levels were significantly higher with ICS therapy responses (increase in FEV1 is equal to or more than 200ml) than no reactions (P<0.05). AUC of using the baseline FeNO value diagnosis of responses and no responses was 0.931, an the cut off was 29.1 ppb.