Tuberc Respir Dis > Accepted Articles
DOI:    [Accepted]
Published online March 5, 2024.
Lack of association between Inhaled Corticosteroid use based on the Exhaled Nitric Oxide and Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Bo-Guen Kim1, Sun Hye Shin2, Jung-Wan Yoo3, Yong Suk Jo4, Hye Yun Park2
1Division of Pulmonary and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
3Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Gyeongsang National University Hospital, Gyeongsang National University, Jinju, Republic of Korea
4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
Correspondence:  Yong Suk Jo, Tel: (+82) 02-2258-6067, Fax: (+82) 02-599-3589, 
Hye Yun Park, Tel: (+82) 02-3410-3429, Fax: (+82) 02-3410-3849, 
Received: 27 October 2023   • Revised: 28 December 2023   • Accepted: 29 February 2024
*Bo-Guen Kim and Sun Hye Shin contributed equally to this study as co-first authors.
Fractional exhaled nitric oxide (FeNO) is known to useful biomarker for detecting eosinophilic airway inflammation. However, there is a lack of evidence regarding the role of FeNO in chronic obstructive pulmonary disease (COPD). We aimed to assess whether elevated FeNO and its impact on treatment change into an inhaled corticosteroid (ICS)-containing regimen and association with acute exacerbation (AE) in patients with COPD.
We retrospectively analyzed 107 COPD patients without history of asthma from March 2016 to December 2019. The patients whose FeNO value was more than 50 parts per billion [ppb] were defined into the high FeNO group. Multivariable analysis with logistic regression was used to identify factors associated with AE in COPD.
The median FeNO value was 32 (Interquartile range [IQR], 19-45) ppb, and 34 (20.0%) patients were classified as high FeNO group (median 74ppb). In the high FeNO group, changes in inhaler treatment into an ICS-containing regimen occurred in 23 of 34 patients after the measurement of FeNO. In multivariate analysis, high FeNO was not a contributing factor for AE, but only the high blood eosinophil count (≥ 300 cells/µL) was associated with AE (adjusted odds ratio, 2.63; 95% confidence interval, 1.01-6.91; p = 0.049).
High FeNO value had a significant impact on the prescription of ICSs in COPD patients, but it did not show a significant association with AE either on its own or with changes in treatment.

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