Abstract

Research Article

Short-term responses to high-dose inhaled corticosteroid treatment in patients with chronic obstructive pulmonary disease with a fractional nitric oxide concentration over 35 parts per billion: A single-centre pre–post study

Akihiro Shiroshita*, Yu Tanaka, Kei Nakashima, Atsushi Shiraishi, Hiroki Matsui and Masahiro Aoshima

Published: 06 October, 2020 | Volume 4 - Issue 1 | Pages: 012-017

Introduction: There is currently no strategy for identifying chronic obstructive pulmonary disease (COPD) patients whose pulmonary function could benefit from inhaled corticosteroids. We investigated whether a 28-day regime of inhaled corticosteroids improved pulmonary function test results among COPD patients with a fractional exhaled nitric oxide concentration > 35 parts per billion.

Methods: This single-centre one-arm pre–post trial included COPD patients with a fractional exhaled nitric oxide concentration > 35 parts per billion treated at our institution from September 2018 to August 2019. Patients were administered budesonide (200 μg, 8 puffs daily) for 28 days. The primary outcome measure was the difference between the forced expiratory volume in 1 s (FEV1) at baseline and after 28 days of inhaled corticosteroid treatment. Secondary outcomes included differences in COPD Assessment Test scores, %FEV1, and that between the percent forced vital capacity (%FVC) at baseline and after 28 days of treatment.

Results: Twenty patients completed the 28-day inhaled corticosteroid regime. The mean difference in FEV1 between day 1 and day 28 was 340 mL (95% confidence interval: −100 to 770 mL; p = 0.122). The mean differences in secondary outcomes were: %FVC, −0.16% (95% confidence interval [CI]: −2.84 to 2.53%; p = 0.905); %FEV1, 1.63% (95%CI: −4.56 to 7.81%; p = 0.589); COPD Assessment Test score, −2.50 (95%CI: −5.72 to 0.72; p = 0.121).

Conclusion: The 28-day course of inhaled corticosteroids yielded no significant difference in FEV1 for COPD patients with a fractional exhaled nitric oxide concentration > 35 parts per billion.

Trial registration: University Hospital Medical Information Network Center, UMIN000034005. Registered 3 September 2018.

https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000038557

Read Full Article HTML DOI: 10.29328/journal.aaai.1001020 Cite this Article Read Full Article PDF

Keywords:

Chronic obstructive pulmonary disease; Fractional exhaled nitric oxide; Inhaled corticosteroid; Pulmonary function test

References

  1. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007; 370: 741. PubMed: https://pubmed.ncbi.nlm.nih.gov/17765523/
  2. Boulet LP, Reddel HK, Bateman E, Pedersen S, FitzGerald JM, et al. The Global Initiative for Asthma (GINA): 25 years later. Eur Respir J. 2019; 29:1900598. PubMed: https://pubmed.ncbi.nlm.nih.gov/31273040/
  3. Alshabanat A, Zafari Z, Albanyan O, Dairi M, FitzGerald JM. Asthma and COPD Overlap Syndrome (ACOS): A systematic review and meta-analysis. PLoS One. 2015; 10: e0136065. https://pubmed.ncbi.nlm.nih.gov/26336076/
  4. Hardin M, Cho M, McDonald ML, et al. The clinical and genetic features of COPD-asthma overlap syndrome. Eur Respir J. 2014; 44: 341-350. PubMed: https://pubmed.ncbi.nlm.nih.gov/24876173/
  5. Singh D, Agusti A, Anzueto A, Beaty T, Ramsdell J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: the GOLD science committee report 2019. Eur Respir J. 2019; 53: 1900164. PubMed: https://pubmed.ncbi.nlm.nih.gov/24876173/
  6. Soler-Cataluña JJ, Novella L, Soler C, Nieto ML, Esteban V, et al. Clinical characteristics and risk of exacerbations associated with different diagnostic criteria of asthma-COPD overlap. Arch Bronconeumol. 2020; 56: 282-290. PubMed: https://pubmed.ncbi.nlm.nih.gov/31784349/
  7. Sin DD, Miravitlles M, Mannino DM, Soriano JB, Price D, et al. What is asthma-COPD overlap syndrome? Towards a consensus definition from a round table discussion. Eur Respir J. 2016; 48: 664-673. PubMed: https://pubmed.ncbi.nlm.nih.gov/27338195/
  8. The Japanese Respiratory Society Guidelines for the Management of Asthma and COPD Overlap. 2018.
  9. Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med. 2011; 184: 602-615. PubMed: https://pubmed.ncbi.nlm.nih.gov/21885636/
  10. American Thoracic Society. European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med. 2005; 171: 912-930. PubMed: https://pubmed.ncbi.nlm.nih.gov/15817806/
  11. Leigh R, Pizzichini MM, Morris MM, Maltais F, Hargreave FE, et al. Stable COPD: predicting benefit from high-dose inhaled corticosteroid treatment. Eur Respir J. 2006; 27:964-971. PubMed: https://pubmed.ncbi.nlm.nih.gov/16446316/
  12. Brightling CE, McKenna S, Hargadon B, Birring S, Green R, et al. Sputum eosinophilia and the short-term response to inhaled mometasone in chronic obstructive pulmonary disease. Thorax. 2005; 60: 193-198. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1747331/
  13. Brightling CE, Monteiro W, Ward R, Parker D, Morgan MD, et al. Sputum eosinophilia and short-term response to prednisolone in chronic obstructive pulmonary disease: a randomised controlled trial. Lancet. 2000; 356:1480-1485. PubMed: https://pubmed.ncbi.nlm.nih.gov/11081531/
  14. Pizzichini E, Pizzichini MM, Gibson P, Parameswaran K, Gleich GJ, et al. Sputum eosinophilia predicts benefit from prednisone in smokers with chronic obstructive bronchitis. Am J Respir Crit Care Med. 1998; 158: 1511-1517. PubMed: https://pubmed.ncbi.nlm.nih.gov/9817701/
  15. Culver BH, Graham BL, Coates AL, Wanger J, Berry CE, et al. Recommendations for a standardized pulmonary function report. An official American Thoracic Society Technical statement. Am J Respir Crit Care Med. 2017; 196: 1463-1472. PubMed: https://pubmed.ncbi.nlm.nih.gov/29192835/
  16. org [Internet]. Tennessee: Vanderbilt University; c2004. https://projectredcap.org/.
  17. r-project.org. [Internet]. The R Foundation. 2018. https://www.r-project.org/.
  18. Tamada T, Sugiura H, Takahashi T, Matsunaga K, Kimura K, et al. Biomarker-based detection of asthma-COPD overlap syndrome in COPD populations. Int J Chron Obstruct Pulmon Dis. 2015; 10: 2169-2176. PubMed: https://pubmed.ncbi.nlm.nih.gov/26491283/
  19. Papi A, Romagnoli M, Baraldo S, Braccioni F, Guzzinati I, et al. Partial reversibility of airflow limitation and increased exhaled NO and sputum eosinophilia in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000; 162: 1773-1777. PubMed: https://pubmed.ncbi.nlm.nih.gov/11069811/
  20. Akamatsu K, Matsunaga K, Sugiura H, Koarai A, Hirano T, et al. Improvement of airflow limitation by fluticasone propionate/salmeterol in chronic obstructive pulmonary disease: What is the specific marker? Front Pharmacol. 2011; 2: 36. PubMed: https://pubmed.ncbi.nlm.nih.gov/21811461/
  21. Szefler SJ, Wenzel S, Brown R, Erzurum SC, Fahy JV, et al. Asthma outcomes: biomarkers. J Allergy Clin Immunol. 2012; 129(3 Suppl): S9-S23. PubMed: https://pubmed.ncbi.nlm.nih.gov/22386512/
  22. Pizzichini MM, Pizzichini E, Clelland L, Efthimiadis A, Mahony J, et al. Sputum in severe exacerbations of asthma: kinetics of inflammatory indices after prednisone treatment. Am J Respir Crit Care Med. 1997; 155: 1501-1508. PubMed: https://pubmed.ncbi.nlm.nih.gov/9154849/
  23. Roche N, Chapman KR, Vogelmeier CF, Herth FJF, Thach C, et al. Blood eosinophils and response to maintenance chronic obstructive pulmonary disease treatment. Data from the FLAME trial. Am J Respir Crit Care Med. 2017; 195: 1189-1197. PubMed: https://pubmed.ncbi.nlm.nih.gov/28278391/
  24. Watz H, Tetzlaff K, Wouters EF, Kirsten A, Magnussen H, et al. Blood eosinophil count and exacerbations in severe chronic obstructive pulmonary disease after withdrawal of inhaled corticosteroids: a post-hoc analysis of the WISDOM trial. Lancet Respir Med. 2016; 45: 390-398. PubMed: https://pubmed.ncbi.nlm.nih.gov/27066739/
  25. Kalinina EP, Denisenko YK, Vitkina TI, Lobanova EG, Novgorodtseva TP, et al. The mechanisms of the regulation of immune response in patients with comorbidity of chronic obstructive pulmonary disease and asthma. Can Respir J. 2016; 2016: 4503267. PubMed: https://pubmed.ncbi.nlm.nih.gov/27660519/
  26. Ansotegui IJ, Melioli G, Canonica GW, Caraballo L, Villa E, et al. IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. World Allergy Organ J. 2020; 13: 100080. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044795/
  27. Vestbo J, Anderson W, Coxson HO, Crim C, Dawber F, et al. Evaluation of COPD longitudinally to identify predictive surrogate end-points (ECLIPSE). Eur Respir J. 2008; 31: 869-873. PubMed: https://pubmed.ncbi.nlm.nih.gov/18216052/

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