Óxido nítrico alveolar y bronquial en la enfermedad pulmonar obstructiva crónica y el solapamiento de asma y EPOC (ACO) / Alveolar and Bronchial Nitric Oxide in Chronic Obstructive Pulmonary Disease and Asthma-COPD Overlap

Introducción: La medición del óxido nítrico en el aire exhalado diferencia fenotipos de pacientes con EPOC del solapamiento de asma y EPOC (ACO). Hasta el momento no se ha estudiado si existen diferencias entre los componentes alveolar y bronquial del FENO en este grupo de pacientes. Métodos: Estudio observacional transversal realizado en consultas externas de Neumología, incluyendo a pacientes con diagnóstico de EPOC a los que se les realizó una determinación del óxido nítrico en aire exhalado - FENO - diferenciando en esta medida el componente alveolar -CANO- y el de vía aérea central -JawNO-, y realizando las mediciones a distintos flujos. Se compararon los valores de CANO y JawNO entre los pacientes con eosinofilia (definidos como aquellos pacientes con ≥ 300 eosinófilos/ μL en sangre periférica, o bien ≥ 2% eosinófilos o ≥ 3% eosinófilos) y se realizó un análisis de regresión lineal para estudiar las variables clínicas y biológicas que se asociaban a estas mediciones. Resultados: Participaron en el estudio 73 pacientes con EPOC. Los criterios de eosinofilia utilizados se asociaban a incrementos de los valores de CANO y de JawNO (en este último caso solo los criterios ≥ 300 eosinófilos y ≥ 3% eosinófilos). CANO se asoció al recuento de eosinófilos y PCR, y JawNO se asoció a tabaquismo y recuento de eosinófilos. Conclusiones: Los pacientes diagnosticados de EPOC y que tienen características de ACO muestran mayor inflamación a nivel bronquial y de vía aérea pequeña. CANO y JawNO se relacionan con variables clínicas y biológicas

Introduction: Exhaled nitric oxide (FENO) measurements differentiate COPD phenotypes from asthma-COPD overlap (ACO). To date, no study has been conducted to determine whether alveolar and bronchial components differ in this group of patients. Methods: This was an observational cross-sectional study recruiting ambulatory COPD patients. FENO was measured, differentiating alveolar (CANO) from bronchial (JawNO) components using a multiple-flow technique. CANO and JawNO values were compared between eosinophilic COPD patients (defined as ≥ 300 eosinophils/μL in peripheral blood test, or ≥ 2% eosinophils or ≥ 3% eosinophils), and a linear regression analysis was performed to determine clinical and biological variables related to these measurements. Results: 73 COPD patients were included in the study. Eosinophil counts were associated with increased values of CANO and JawNO (for the latter only the association with ≥ 300 or ≥ 3% eosinophils was significant). CANO was also associated with CRP, and JawNO with smoking. Conclusions: Patients with COPD and ACO characteristics show increased inflammation in the large and small airways. CANO and JawNO are associated with clinical and biological variables

Alveolar and Bronchial Nitric Oxide in Chronic Obstructive Pulmonary Disease and Asthma-COPD Overlap. / Óxido nítrico alveolar y bronquial en la enfermedad pulmonar obstructiva crónica y el solapamiento de asma y EPOC (ACO).

INTRODUCTION: Exhaled nitric oxide (FENO) measurements differentiate COPD phenotypes from asthma-COPD overlap (ACO). To date, no study has been conducted to determine whether alveolar and bronchial components differ in this group of patients. METHODS: This was an observational cross-sectional study recruiting ambulatory COPD patients. FENO was measured, differentiating alveolar (CANO) from bronchial (JawNO) components using a multiple-flow technique. CANO and JawNO values were compared between eosinophilic COPD patients (defined as ≥ 300 eosinophils/µL in peripheral blood test, or ≥ 2% eosinophils or ≥ 3% eosinophils), and a linear regression analysis was performed to determine clinical and biological variables related to these measurements. RESULTS: 73 COPD patients were included in the study. Eosinophil counts were associated with increased values of CANO and JawNO (for the latter only the association with ≥ 300 or ≥ 3% eosinophils was significant). CANO was also associated with CRP, and JawNO with smoking. CONCLUSIONS: Patients with COPD and ACO characteristics show increased inflammation in the large and small airways. CANO and JawNO are associated with clinical and biological variables.

Guías clínicas en asma y enfermedad pulmonar obstructiva crónica: ¿cuál es su utilidad en la práctica clínica? / Clinical Guidelines in Asthma and Chronic Obstructive Pulmonary Disease: How Useful Are They in Clinical Practice?

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Futuro de la triple terapia en la enfermedad pulmonar obstructiva crónica / The Future of Triple Therapy in chronic obstructive pulmonary disease

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