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Improvement of Airflow Limitation by Fluticasone Propionate/Salmeterol in Chronic Obstructive Pulmonary Disease: What is the Specific Marker?

Akamatsu K, Matsunaga K, Sugiura H, Koarai A, Hirano T, Minakata Y, Ichinose M - Front Pharmacol (2011)

Bottom Line: The baseline FE(NO) levels and positive specific IgE (atopy+) were significantly associated with airway obstructive changes assessed by FEV(1) and ΔN(2).A baseline FE(NO) level >35 ppb yielded 80.0% sensitivity and 66.7% specificity for identifying the subjects with significant improvement in FEV(1) (greater than 200 mL).Alternatively, COPD subjects with FE(NO) ≤ 35 ppb and atopy- did not show significant improvement in FEV(1).

View Article: PubMed Central - PubMed

Affiliation: Third Department of Internal Medicine, School of Medicine, Wakayama Medical University Wakayama, Japan.

ABSTRACT

Backgrounds: Inhaled corticosteroids (ICS)/inhaled long-acting beta(2)-agonists (LABA) combination drugs are widely used for the long-term management of chronic obstructive pulmonary disease (COPD). However, COPD is a heterogeneous condition and treatment with ICS is associated with a higher risk of pneumonia. The identification of a specific marker for predicting the efficacy of ICS/LABA on pulmonary function would be useful in the treatment of COPD.

Methods: Fourteen COPD patients receiving tiotropium therapy participated consecutively. The relationship between the baseline exhaled nitric oxide (FE(NO)) levels as well as serum markers and changes in pulmonary function by fluticasone propionate (FP)/salmeterol (SAL) were analyzed.

Results: FP/SAL therapy significantly improved forced vital capacity, forced expiratory volume in 1 s (FEV(1)), and the third phase slope of the single nitrogen washout curve (ΔN(2)) as well as the FE(NO) level. The baseline FE(NO) levels and positive specific IgE (atopy+) were significantly associated with airway obstructive changes assessed by FEV(1) and ΔN(2). A baseline FE(NO) level >35 ppb yielded 80.0% sensitivity and 66.7% specificity for identifying the subjects with significant improvement in FEV(1) (greater than 200 mL). An atopy+ yielded 60.0% sensitivity and 88.9% specificity for an improvement in FEV(1). When combined with FE(NO) > 35 ppb and atopy+, it showed 40% sensitivity and 100.0% specificity for FEV(1) improvement. Alternatively, COPD subjects with FE(NO) ≤ 35 ppb and atopy- did not show significant improvement in FEV(1).

Conclusion: Combining FE(NO) and specific IgE may be a useful marker for predicting the response to ICS/LABA on airflow limitation in COPD.

No MeSH data available.


Related in: MedlinePlus

Correlation between baseline levels of FENO and FP/SAL-mediated changes in FEV1(A) and slope of the single breath nitrogen washing curve [ΔN2(B)]. The lines correspond to the fitted regression of the equation. Baseline ΔN2 values/ΔN2 values after FP/SAL combination treatment was defined as ΔN2 ratio.
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Figure 2: Correlation between baseline levels of FENO and FP/SAL-mediated changes in FEV1(A) and slope of the single breath nitrogen washing curve [ΔN2(B)]. The lines correspond to the fitted regression of the equation. Baseline ΔN2 values/ΔN2 values after FP/SAL combination treatment was defined as ΔN2 ratio.

Mentions: The baseline FENO level was not associated with the changes in FEV1 (r = −0.16, p = 0.60), but significantly correlated with the changes in ΔN2 (r = −0.69, p < 0.01; Figure 2). The relationship between the baseline FENO levels and the changes in other pulmonary physiological parameters were not significant. Among the serum markers, the subjects with positive specific IgE showed significantly higher improvement in FEV1 (p < 0.05), but not in ΔN2 (Figure 3). Other serum markers including blood eosinophils, CRP, and total IgE levels were not correlated with the changes in any physiological parameters.


Improvement of Airflow Limitation by Fluticasone Propionate/Salmeterol in Chronic Obstructive Pulmonary Disease: What is the Specific Marker?

Akamatsu K, Matsunaga K, Sugiura H, Koarai A, Hirano T, Minakata Y, Ichinose M - Front Pharmacol (2011)

Correlation between baseline levels of FENO and FP/SAL-mediated changes in FEV1(A) and slope of the single breath nitrogen washing curve [ΔN2(B)]. The lines correspond to the fitted regression of the equation. Baseline ΔN2 values/ΔN2 values after FP/SAL combination treatment was defined as ΔN2 ratio.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3140651&req=5

Figure 2: Correlation between baseline levels of FENO and FP/SAL-mediated changes in FEV1(A) and slope of the single breath nitrogen washing curve [ΔN2(B)]. The lines correspond to the fitted regression of the equation. Baseline ΔN2 values/ΔN2 values after FP/SAL combination treatment was defined as ΔN2 ratio.
Mentions: The baseline FENO level was not associated with the changes in FEV1 (r = −0.16, p = 0.60), but significantly correlated with the changes in ΔN2 (r = −0.69, p < 0.01; Figure 2). The relationship between the baseline FENO levels and the changes in other pulmonary physiological parameters were not significant. Among the serum markers, the subjects with positive specific IgE showed significantly higher improvement in FEV1 (p < 0.05), but not in ΔN2 (Figure 3). Other serum markers including blood eosinophils, CRP, and total IgE levels were not correlated with the changes in any physiological parameters.

Bottom Line: The baseline FE(NO) levels and positive specific IgE (atopy+) were significantly associated with airway obstructive changes assessed by FEV(1) and ΔN(2).A baseline FE(NO) level >35 ppb yielded 80.0% sensitivity and 66.7% specificity for identifying the subjects with significant improvement in FEV(1) (greater than 200 mL).Alternatively, COPD subjects with FE(NO) ≤ 35 ppb and atopy- did not show significant improvement in FEV(1).

View Article: PubMed Central - PubMed

Affiliation: Third Department of Internal Medicine, School of Medicine, Wakayama Medical University Wakayama, Japan.

ABSTRACT

Backgrounds: Inhaled corticosteroids (ICS)/inhaled long-acting beta(2)-agonists (LABA) combination drugs are widely used for the long-term management of chronic obstructive pulmonary disease (COPD). However, COPD is a heterogeneous condition and treatment with ICS is associated with a higher risk of pneumonia. The identification of a specific marker for predicting the efficacy of ICS/LABA on pulmonary function would be useful in the treatment of COPD.

Methods: Fourteen COPD patients receiving tiotropium therapy participated consecutively. The relationship between the baseline exhaled nitric oxide (FE(NO)) levels as well as serum markers and changes in pulmonary function by fluticasone propionate (FP)/salmeterol (SAL) were analyzed.

Results: FP/SAL therapy significantly improved forced vital capacity, forced expiratory volume in 1 s (FEV(1)), and the third phase slope of the single nitrogen washout curve (ΔN(2)) as well as the FE(NO) level. The baseline FE(NO) levels and positive specific IgE (atopy+) were significantly associated with airway obstructive changes assessed by FEV(1) and ΔN(2). A baseline FE(NO) level >35 ppb yielded 80.0% sensitivity and 66.7% specificity for identifying the subjects with significant improvement in FEV(1) (greater than 200 mL). An atopy+ yielded 60.0% sensitivity and 88.9% specificity for an improvement in FEV(1). When combined with FE(NO) > 35 ppb and atopy+, it showed 40% sensitivity and 100.0% specificity for FEV(1) improvement. Alternatively, COPD subjects with FE(NO) ≤ 35 ppb and atopy- did not show significant improvement in FEV(1).

Conclusion: Combining FE(NO) and specific IgE may be a useful marker for predicting the response to ICS/LABA on airflow limitation in COPD.

No MeSH data available.


Related in: MedlinePlus