| Objective:To investigate whether baseline exhaled nitric oxide(Fe NO)can measure the overall treatment outcome during the acute exacerbation period and to determine the COPD patients who benefit from inhaled glucocorticoids(ICS).Methods:The first stage: 211 cases of patients diagnosed as COPD at the Department of Respiratory Medicine of the First Hospital of Jilin University from April 2016 to January 2018,aged 64.13±9.81 years,including 105 males and 106 females.The diagnostic criteria were in line with the 2019 guidelines for global prevention and treatment of chronic obstructive pulmonary disease.The patients enrolled on the day of admission were performed lung function,Fe NO,sputum induction,blood routine,serum protein Ig E examination,and CAT score.All patients were divided into mild-to-moderate COPD and severely severe COPD according to the GOLD grading criteria.Clinical characteristics and correlation between baseline Fe NO values and airway reversibility were analyzed.Each patient received inhaled corticosteroids and bronchodilators treatment.We repeated Pulmonary function and CAT scores at discharge,hospital stay was collected.According to the American Thoracic Society(ATS)guidelines,patients with a first-second maximum expiratory volume(FEV1)> 0.2L after treatment were defined as a good response group,and a FEV1 elevation value of 0.2L was a poor response group.Baseline Fe NO values were compared between the two groups.The correlation between the Fe NO value of all subjects and the improvement of FEV1 during treatment,the increase of CAT score,and the length of stay were analyzed.The second stage: the patients enrolled would return to the hospital to review the lung function and retest CAT score at 1 month and 3 month after discharge.According to the post-discharge medication plan of the attending physicians,the patients were randomly divided into two groups,which were treated with the combination of symbicort turbuhaler and tiotropium bromide or tiotropium alone.The number of patients who returned to the hospital after 1 month was 37 and the number of patients who returned to hospital after 3 months was 7.These patients were divided into high Fe NO/ICS+LABA+ LAMA,high Fe NO/LAMA,low Fe NO/ICS+LABA+LAMA,low Fe NO/LAMA 4 groups according to baseline Fe NO value and post-discharge medication.The differences between the four groups of patients at 1 month and 3 months were compared with the improvement of FEV1 and the improvement of CAT score.Result:(1)Baseline Fe NO values were positively correlated with blood eosinophils,percentage of sputum eosinophils,and Ig E levels in all enrolled patients.(2)In the first stage,the baseline Fe NO,the absolute value of blood eosinophils,and the percentage of sputum eosinophils were higher in the patients with better response during hospitalization than in the poor response group,the difference was statistically significant(P<0.05).(3)In the first stage,the baseline Fe NO values were positively correlated with the change of FEV1 and negatively correlated with the hospital stays.(4)In the first stage,ROC curve was used to analyze the predictive value of Fe NO values on treatment response during hospitalization.The area under the curve was 0.858(P<0.01).The optimal Fe NO cut point for predicting the increase of FEV1 during treatment was 41 ppb,the sensitivity was 0.722,and the specificity was 0.879.(5)In the second stage,there was no difference in the degree of improvement in FEV1 and the improvement in CAT scores between 4 groups.Conclusion:(1)The baseline Fe NO value of patients with acute exacerbation of chronic obstructive pulmonary disease is positively correlated with blood and sputum eosinophils,and can be used as a marker of eosinophilic airway inflammation,which can reflect the degree of airway reversibility.(2)Baseline Fe NO values predict the treatment effect of AECOPD patients during hospitalization.(3)Fe NO values may not be an independent reference factor for determining whether COPD patients are treated with ICS after discharge. |
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