Significance And Clinical Value Of Exhaled Nitric Oxide In Elderly Patients With Chronic Obstructive Pulmonary Disease

Background and objective Chronic obstructive pulmonary disease(COPD)is a common and frequently-occurring disease of the respiratory system in the elderly,which is divided into acute exacerbation COPD(AECOPD)and stable COPD.The nature of COPD is non-specific chronic airway inflammation.Various inflammatory cells such as neutrophils,macrophages,lymphocytes,and eosinophils are involved in the occurrence of chronic inflammation.Exhaled nitric oxide(FeNO)detection is a non-invasive,simple,and reproducible test that can directly quantify airway inflammation,it mainly reflecting eosinophilic airway inflammation.The purpose of this study was to investigate whether FeNO can reflect the level of airway inflammation in COPD patients,whether it can identify the type of inflammation in AECOPD patients,and guide the treatment of glucocorticoids.Methods A total of 120 elderly patients diagnosed with AECOPD,120 elderly patients with stable COPD and 120 non-respiratory patients in the control group who were selected to the Wuhan NO.1 Hospital from December 2018 to December 2019.Patients with AECOPD were evaluated for the degree of dyspnea using the mMRC after admission.The clinical manifestations,FeNO,NEUT%,EOS%,CRP,FEV1%,FEV1/FVC% were recorded in the AECOPD group,the stable COPD group,and the control group.According to the ATS/ ERS and using a cut-off value of 25 ppb,the patients in the AECOPD group were divided into 72 cases of high-level group(FeNO?25ppb)and 48 cases of low-level group(FeNO<25ppb).The high-level group was randomly divided into without hormone treatment group(n=36)and hormone treatment group(n=36).The low-level group was randomly divided into without hormone treatment group(n=24)and hormone treatment group(n=24).The non-hormonal treatment group was given symptomatic treatment such as anti-infection,expectorant,anti-asthmatic,and oxygen inhalation,and no hormone was used.In the hormone-treated group,in addition to conventional therapy,inhaled glucocorticoids and/or intravenous methylprednisolone were used.The clinical symptoms and the changes of FeNO in each group were recorded after one week of treatment.Patients who did not usehormone therapy during treatment,if symptoms and signs did not improve significantly,were treated with hormone therapy in time.The treatment effect of such patients was calculated as invalid.Results 1.FeNO,NEUT%,EOS%,and CRP in the AECOPD group were significantly higher than the stable COPD group and the control group,and FEV1% and FEV1/FVC% in the AECOPD group were significantly lower than the stable COPD group and the control group(P<0.001).There was no significant difference in FeNO,NEUT%,EOS%,and CRP between COPD stable phase and the control group(P>0.05).FEV1%,FEV1/FVC% of the COPD stable group were lower than the control group(P<0.05).2.The results of Pearson correlation analysis showed that there was a positive correlation between FeNO and EOS% in the AECOPD group and the stable COPD group(r=0.657,P <0.001;r=0.542,P<0.001).But no correlation between FeNO and NEUT%,CRP,FEV1%,FEV1/FVC%(P> 0.05).3.In the high-level group,the FeNO value in the hormone-treated group decreased significantly after treatment(P<0.001),but there was no significant difference in FeNO value before and after treatment in the non-hormone-treated group(P>0.05).In the low-level group,there was no significant difference in FeNO values before and after treatment between the hormone-treated group and the non-hormone-treated group(P> 0.05).4.In the high-level group and the low-level group of the non-hormonal treatment group,there were 10 cases and 2 cases with no significant relief in symptoms and signs during the treatment.After the timely treatment with hormones,the symptoms improved.5.In the high-level group,the therapeutic effect of the hormonal treatment group was significantly better than the non-hormonal treatment group(P<0.05).In the low-level group,there was no significant difference in the efficacy of the hormonal treatment group compared with the non-hormonal treatment group(P> 0.05).Conclusion 1.FeNO can reflect the level of airway inflammation in patients with COPD,especially in patients with AECOPD.But it cannot reflect the degree of airflow limitation in patients.2.FeNO has a certain significance in identifying the inflammation types of AECOPD(neutrophils,eosinophils),and provides a basis for the selection of treatment options(antibiotics,hormones).3.In this study,the higher the FeNO value,the better the efficacy of glucocorticoids in patients with AECOPD,which can be used to guide the treatment of glucocorticoids.