Predicting Corticosteroid Response in Chronic Obstructive Pulmonary Disease Using Exhaled Nitric Oxide

• DOI: 10.1164/rccm.200905-0685oc
• Publication Date: 2009-08-07T01:43:17Z
• Authors: Jack F. Dummer; Michael J. Epton; Jan O. Cowan; Julie M. Cook; Robin Condliffe; C. Erik Landhuis; Andrew D. Smith; D. Robin Taylor
• Keywords: Crossover study; Exhalation

Predicting corticosteroid response in COPD is important but difficult. Response more likely to occur association with eosinophilic airway inflammation, for which the fraction of exhaled nitric oxide (Fe(NO)) a good surrogate marker.We aimed establish whether Fe(NO) levels would predict clinical oral COPD.We performed double-blind, crossover trial steroid patients COPD. After 4-week washout inhaled steroids, received prednisone 30 mg/d or matching placebo, random order, an intervening washout. The predictive values clinically significant changes 6-minute-walk distance (6MWD), spirometry (FEV(1)), and St. George's Respiratory Questionnaire (SGRQ) were calculated.A total 65 (mean FEV(1) = 57% predicted) randomized. With prednisone, there was net increase 13 m 6MWD (P 0.02) 0.06 L postbronchodilator compared placebo. change SGRQ not significant. Using receiver operator characteristic analysis, area under curve 0.2 0.69 0.04) optimum cut-point 50 ppb. positive negative 67 82%, respectively. FE(NO) predictor SGRQ.Fe(NO) weak short-term COPD, its usefulness being limited predicting FEV(1). Clinical registered www.anzctr.org.au (ACTRN12605000683639).