Exhaled nitric oxide monitoring in COPD using a portable analyzer

BACKGROUND: The exhaled nitric oxide (FeNO) is a non-invasive marker of airway inflammation in asthma. A very recent statement has suggested FeNO as potential outcome in chronic obstructive pulmonary disease (COPD). Recently, a new hand-held FeNO analyzer (NIOX MINO) has been developed. PATIENTS AND METHODS: We have evaluated the NIOX MINO in COPD patients and monitored FeNO levels during 1-year assessment in the outpatient setting. Short-term variability in FeNO was compared using a NIOX MINO and a stationary chemiluminescence analyzer (NOA, Sensormedics) in healthy volunteers and COPD patients on two consecutive months. Long-term FeNO variability was assessed on a cohort of 70 COPD outpatients measuring FeNO for 1 year. The intra-individual FeNO coefficient of variation (eNOCoV) was taken as index FeNO long-term variability. RESULTS: In COPD there were no significant differences between NIOX MINO and NOA FeNO values recorded at baseline and 1 month later. Ninety five percent limits of agreement between NIOX MINO and NOA were-2.7 and 1.9ppb with significant reliability (r=0.96, p<0.0001). Mean FeNO at baseline was 15.0+/-9.5ppb. Over the 1-year period the overall mean FeNO was 15.5+/-10.1ppb. The long-term eNOCoV was 33.9+/-16.4% (range 8.1-83.1%), and it was significantly associated with exacerbation rate (r=0.57, p<0.0001). CONCLUSION: FeNO electrochemical hand-held analyzer is feasible in COPD showing good agreement with stationary chemiluminescence analyzer. COPD patients exhibit a wide range of FeNO levels and a high variability of FeNO over time, which was positively associated with the number of exacerbations.     

Analysis of Hospitalizations for COPD Exacerbation: Opportunities for Improving Care

ABSTRACT

Background: Little is known about the actual treatment of patients with chronic obstructive pulmonary disease (COPD), either in the inpatient or outpatient settings. We hypothesized that there are substantial opportunities for improvement in adherence with current guidelines and recommendations. Methods: We reviewed the medical records of all patients hospitalized with acute exacerbation of COPD between January 2005 and December 2006 at 5 New York City hospitals. Results: There were 1285 unique patients with 1653 hospitalizations. Of these 1653, 83% were for patients with a prior history of COPD and 368 (22%) represented repeat admissions during our study period. The majority were treated during their hospitalization with a combination of systemic steroids (85%), bronchodilators (94%) and antibiotics (80%). There were 59 deaths (3.6%). Smoking cessation counseling was offered to 48% of active smokers. Influenza and pneumococcal vaccines were administered to half of eligible patients. On discharge, only 46.0% were prescribed maintenance bronchodilators and 24% were not prescribed any inhaled therapy. Even in the 226 unique patients (17.6%) readmitted at least once during course of the study, on discharge only 44.7% were prescribed maintenance bronchodilators and 23% were not prescribed any regular inhaled therapy. Conclusions: Patients hospitalized with acute exacerbation of COPD generally receive adequate hospital care, but there may be opportunities to improve care pharmacologically and with smoking cessation counseling and vaccination during and after hospitalization.     

Possible pathogenic roles of nitric oxide in asthma

Nitric oxide (NO) has broad physiologic functions, including vasodilation, bronchodilatation, neurotransmission, inflammation, and host defense. Fraction of exhaled NO (FeNO) is used as a biomarker of eosinophilic airway inflammation for asthma control. However, the role of NO in the pathogenesis and progression of asthma is not well understood. Additionally, the absence of bronchial eosinophilic inflammation, mucus hypersecretion, and increased Th2 cytokine levels in mice lacking NO synthase isoforms (n/i/eNOS^?/-), suggests that NO has an essential role in the promoting the pathogenesis of asthma. Recent clinical data investigating antibodies for interleukin (IL)-4 receptor α, which inhibits both IL-4 and IL-13 signaling, and anti-IL-13 antibody suggest a unique association between NO and the pathogenesis and progression of asthma. Antibody therapies targeting several cytokines may provide clues to elucidate the mechanisms underlying the pathogenesis and progression of asthma.     

一氧化氮及其合酶在哮喘发病机制中的作用

探讨一氧化氮及其合酶在哮喘发病机制中的作用。方法 采用哮喘豚鼠模型，将豚鼠分为４组；１．哮喘组，用１０％卵白蛋白腹腔注射１ｍｌ致敏，２周后用１％卵白蛋白超声雾化吸入致其哮喘发作．２；肾上腺皮质激素预防组；诱喘同哮喘组，在每次诱喘前腹腔滴注地塞米松０．５ｍｇ／ｋｇ。３．硝基精氨酸甲酯预防组；诱喘同哮喘组，每次诱喘产腹腔注射ＬＮＮＡ０．４ｍｇ／ｋｇ。４．正常对照组；用生理盐水代替诱喘剂。每组分别测定其     

Automated Telecommunication to Obtain Longitudinal Follow-up in a Multicenter Cross-sectional COPD Study

Abstract

Background. It can be challenging to maintain longitudinal follow-up of subjects in clinical studies. COPDGene is a multicenter, observational study designed to identify genetic factors associated with COPD and to characterize COPD-related phenotypes. To obtain follow-up data on patient's vital status and outcomes, the COPDGene Longitudinal Follow-up (LFU) Program was developed to supplement its parent study. Methods/Results. We used a telecommunication system that employed automated telephone contact or web-based questions to obtain longitudinal follow-up data in our subjects. A branching questionnaire asked about exacerbations, new therapies, smoking status, development of co-morbid conditions, and general health status. Study coordinators contacted subjects who did not respond to one of the automated methods. We enrolled 10,383 subjects in the COPDGene study. As of August 29, 2011, 7,959 subjects completed 19,955 surveys. On the first survey, 68.8% of subjects who completed their survey did so by electronic means, while 31.3% required coordinator phone follow-up. On each subsequent survey the number of subjects who completed their survey by electronic means increased, while the number of subjects who required coordinator follow-up decreased. Despite many of the patients in the cohort being chronically ill and elderly, there was broad acceptance of the system with over half the cohort using electronic response methods. Conclusions. The COPDGene LFU Study demonstrated that telecommunications was an effective way to obtain longitudinal follow-up of subjects in a large multicenter study. Web-based and automated phone contacts are accepted by research subjects and could serve as a model for LFU in future studies.     

Exhaled nitric oxide levels in patients with atopic cough and cough variant asthma

Background and objective:   Atopic cough (AC) is an established clinical entity in Japan, in which patients present with a chronic persistent non-productive cough. Exhaled nitric oxide (NO) is a biomarker of eosinophilic airway inflammation. The present study examined whether exhaled NO levels were increased in AC in comparison with cough variant asthma (CVA) and bronchial asthma (BA).
Methods:   Consecutive patients presenting with an isolated cough lasting at least 8 weeks were enrolled in the study. The aetiology of the chronic cough was determined according to the Japanese Respiratory Society guidelines for management of cough. Exhaled NO, capsaicin cough sensitivity (capsaicin concentration eliciting five or more coughs (C5)) and bronchial reversibility were measured at the patients' first visit. Bronchial responsiveness (PC20 to methacholine) was measured at their second visit following a 6-day course of bronchodilator therapy.
Results:   There were 58 patients recruited and fully investigated; of these 9 and 11 patients were diagnosed with AC and CVA, respectively, as single causes of chronic cough. Ten patients with BA who had not received corticosteroid therapy in the previous 4 weeks and who attended the same clinic in the same time period acted as controls. Exhaled NO levels in patients with AC were significantly lower than those in patients with CVA and BA. There was no significant difference in the exhaled NO levels between patients with CVA and BA.
Conclusions:   Exhaled NO may reflect eosinophilic inflammation of peripheral airways and its measurement may be useful in differentiating CVA from AC and other causes of chronic non-productive cough.     

老年大鼠大脑组织一氧化氮、一氧化氮合酶的变化及神经细胞凋亡研究

目的研究一氧化氮(NO)、一氧化氮合酶(NOS)在老年大鼠大脑中的变化及其与神经细胞凋亡的关系. 方法选用5月龄大鼠和30月龄大鼠,利用Griess反应和高压液相技术间接测量大脑NO水平和NOS活性;免疫组化和原位杂交技术分别检测神经元NOS(nNOS)蛋白质水平和nNOS、bcl-2基因水平;末端转移酶标记法原位检测大脑神经细胞凋亡状况. 结果老年大鼠大脑组织NO水平和nNOS活性分别是(2.61±0.10)μmol*L-1和(398.22±21.62)fmol*mg-1*min-1,显著高于青年大鼠的(1.54±0.15)μmol*L-1和(234.38±16.24)fmol*mg-1*min-1.老年大鼠大脑nNOS的基因水平和蛋白表达水平均升高,抗凋亡基因bcl-2水平降低.在老年大鼠大脑质皮检测到散在的凋亡细胞. 结论老年大鼠大脑组织NO水平升高是由于nNOS活性升高所致.nNOS活性的增高部分是由其基因和蛋白水平来决定的.老年大鼠大脑组织NO异常升高可能是导致神经组织损伤进而凋亡的原因之一.     

Comorbidities, Patient Knowledge, and Disease Management in a National Sample of Patients with COPD

Objective

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States but is often undertreated. COPD often overlaps with other conditions such as hypertension and osteoporosis, which are less morbid but may be treated more aggressively. We evaluated the prevalence of these comorbid conditions and compared testing, patient knowledge, and management in a national sample of patients with COPD.

Methods

A survey was administered by telephone in 2006 to 1003 patients with COPD to evaluate the prevalence of comorbid conditions, diagnostic testing, knowledge, and management using standardized instruments. The completion rate was 87%.

Results

Among 1003 patients with COPD, 61% reported moderate or severe dyspnea and 41% reported a prior hospitalization for COPD. The most prevalent comorbid diagnoses were hypertension (55%), hypercholesterolemia (52%), depression (37%), cataracts (31%), and osteoporosis (28%). Only 10% of respondents knew their forced expiratory volume in 1 second (95% confidence interval [CI], 8-12) compared with 79% who knew their blood pressure (95% CI, 76-83). Seventy-two percent (95% CI, 69-75) reported taking any medication for COPD, usually a short-acting bronchodilator, whereas 87% (95% CI, 84-90) of patients with COPD and hypertension were taking an antihypertensive medication and 72% (95% CI, 68-75) of patients with COPD and hypercholesterolemia were taking a statin.

Conclusion

Although most patients with COPD in this national sample were symptomatic and many had been hospitalized for COPD, COPD self-knowledge was low and COPD was undertreated compared with generally asymptomatic, less morbid conditions such as hypertension.     

阿托伐他汀对冠心病患者血清一氧化氮及一氧化氮合酶含量的影响

目的　观察阿托伐他汀对冠心病患者血清一氧化氮 (NO)及一氧化氮合酶 (NOS)含量水平的影响。方法　对用阿托伐他汀治疗的 79例冠心病患者依据是否合并高胆固醇血症分为两组 ,对其治疗前后血清 NO及 NOS含量水平进行对比分析。结果　不论是否合并高胆固醇血症的冠心病 ,阿托伐他汀均可升高其血清 NO及 NOS水平。结论　阿托伐他汀可通过调脂治疗抑制脂质的过氧化反应 ,保护血管内皮功能 ,但其保护内皮功能的作用不受患者是否存在高脂血症的影响 ,改善内皮功能 ,对冠心病的防治具有重要意义。     

一氧化氮及一氧化氮合酶在低氧性肺动脉高压中的研究进展

一氧化氮可调节肺血管张力,维持肺血管正常结构和肺循环的低阻力状态,在低氧性肺动脉高压的发生机制中起重要作用.由于一氧化氮具有独特的理化性质和生物学活性,因此目前研究主要集中在对其合成的关键酶一氧化氮合酶.下面就一氧化氮、一氧化氮合酶在低氧性肺动脉高压发病中的作用机制及临床应用的研究作一简单综述.     

大鼠组织一氧化氮含量变化及其调节在衰老过程中的作用

目的　揭示大鼠组织一氧化氮 ( NO)含量和一氧化氮合酶 ( NOS)活性变化与衰老的相关关系 ,并通过调节 NO合成 ,探讨 NO在衰老过程中的作用。　方法　对不同月龄大鼠采用铜离子活化镉还原法测定组织 NO含量 ,应用血红蛋白氧化法测定组织 NOS的活性 ,采用硫代巴比妥酸染色法测定组织丙二醛 ( MDA)含量。　结果　与青年组相比 ,老年组 ( 2 0～ 2 2月龄 )心脑肾组织 NO降低有显著性 ( P<0 .0 1 ) ,而中年组仅肾组织 NO含量降低有显著性 ( P<0 .0 5) ;老年组较中年组仅心脏组织 NO含量降低有显著性 ( P<0 .0 1 )。中年组心脑组织 NOS活性较青年组降低 ( P<0 .0 5) ;而老年组组织 NOS活性较中年组增高 ,仅脑组织 NOS增高有显著性 ( P<0 .0 5)。与老年对照组比较 ,β-雌二醇组心肝肾脑组织 NO含量明显增高 ( P<0 .0 1 ) ,而心脑肾组织 MDA下降有显著性 ( P<0 .0 1 ) ;L-硝基精氨酸甲酯组肝组织 NO降低有显著性 ( P<0 .0 5) ,而 MDA下降仅在脑组织有显著性 ( P<0 .0 5)。　结论　大鼠组织 NO含量与衰老之间存在一定的相关关系。     

胃食管反流病患者食管NOS表达及血清NO含量变化的临床意义

目的探讨一氧化氮(NO)在胃食管反流病(GERD)发病机制中的作用.方法应用PC polygraf HR高分辨多通道测压系统检测GERD患者的食管下段括约肌压力(LESP)、食管下段括约肌长度(LESL)及食管远端蠕动幅度等动力参数;应用Digitrapper MK Ⅲ动态食管PH监测仪检测其24小时食管内PH各项参数;应用NADPH-d组化染色观察食管一氧化氮合酶(NOS)表达;应用硝酸还原酶法测定血清NO含量.结果GERD患者的LESP及LESL显著低于对照组(P＜0.01);前者的食管下段蠕动幅度明显低于后者(P＜0.01);前者的食管内24小时PH值明显高于后者;患者食管粘膜NOS呈强阳性反应;其血清NO含量也显著高于对照组.结论内源性NO可能参与GERD的致病机理.     

Exhaled nitric oxide is associated with cyclic changes in sexual hormones

BackgroundWe hypothesized that changes in the levels of sexual hormones during the menstrual cycle influence the concentration of nitric oxide in the exhaled air (FeNO) and alveolar exhaled nitric oxide (CANO).MethodsTwelve healthy, non allergic women in their reproductive age (age range 25–37 years) were recruited. Subjects were studied, on alternate days, over the course of their menstrual cycle. At each visit, measurements of FeNO and CANO were performed. Progesterone and 17-β-estradiol concentrations were measured in salivary samples.ResultsEight subjects completed the study. The levels of FeNO and CANO were 13 ± 4.7 pbb and 3.5 ± 1.9 pbb, respectively (mean ± SD). The mean salivary concentration of progesterone was 65.1 ± 16.2 pg/ml (mean ± SD), with a range of 32.4–107.7 pg/ml, and the concentration of 17 β-estradiol was 6.0 ± 1.6 pg/ml, with a range of 3.1–12.9 pg/ml. The Generalized Estimating Equations procedure demonstrated that levels of progesterone influenced both FeNO and CANO (Wald χ2 = 11.60, p = 0.001; and Wald χ2 = 87.55, p = 0.001, respectively). On the contrary, the salivary levels of 17 β-estradiol were not significantly associated with FeNO (Wald χ2 = 0.087, p = 0.768) or CANO (Wald χ2 = 0.58, p = 0.448).ConclusionIn healthy women, the menstrual cycle-associated hormonal fluctuations selectively influence the levels of bronchial and alveolar NO. The current findings may have important clinical implications for the interpretation of eNO levels, by identifying a patient-related factor that influences the eNO measurements.     

硝酸甘油治疗大鼠骨质疏松症血清NO、NOS的变化

目的初步探讨用硝酸甘油治疗骨质疏松症(OP)及其与一氧化氮(NO)、一氧化氮合酶(NOS)的关系。方法将40只6月龄雌性大鼠随机分成假手术组(15只)和OP模型组(25只),其中OP模型组去卵巢造成骨质疏松模型,从其中随机选5只大鼠测定血清NO、NOS的变化,并与5只假手术组大鼠比较。剩余OP模型组大鼠随机分为OP对照组(10只)与硝酸甘油治疗组(10只),硝酸甘油治疗组经硝酸甘油治疗骨密度升高后,测其血清NO、NOS的变化,并与OP对照组及假手术组比较。结果OP模型组血清NO、NOS低于假手术组(P<0.01,P<0.05)。硝酸甘油治疗组大鼠骨密度升高后,其血清NO、NOS高于OP对照组(P<0.01,P<0.05),而与假手术组差异无显著意义(P>0.05)。结论NO、NOS参与了骨质疏松症的病理生理过程,硝酸甘油治疗骨质疏松症可能与NO、NOS有关。