RESUMO
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
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Óxido Nítrico/análise , Eosinofilia Pulmonar/diagnóstico , Estudos Transversais , Estudo Observacional , Modelos Lineares , Inquéritos e Questionários , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/terapiaRESUMO
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.