Tuberc Respir Dis.  2013 Jan;74(1):7-14.

Measurement of Fractional Exhaled Nitric Oxide in Stable Bronchiectasis

• Cho YJ
• Lim HJ
• Park JS
• Lee JH
• Lee CT
• Yoon HI

Abstract

BACKGROUND
Fractional exhaled nitric oxide (FeNO) can be measured easily, rapidly, and noninvasively for the assessment of airway inflammation, particularly mediated by eosinophil, such as asthma. In bronchiectasis (BE), the pathogenesis has been known as chronic airway inflammation and infection with abnormal airway dilatation; however, there are little studies to evaluate the role of FeNO in BE.
METHODS
From March 2010 to February 2012, 47 patients with BE, diagnosed by high resolution computed tomography (HRCT), performed FeNO, compared with asthma and chronic obstructive pulmonary disease (COPD). All patients carried out a complete blood count including eosinophil count, chemistry, sputum examination, and spirometry, if indicated. A retrospective analysis was performed to elucidate the clinical role of FeNO in BE patients.
RESULTS
The mean FeNO levels in patients with BE was 18.8+/-1.5 part per billion (ppb), compared to 48.0+/-6.4 and 31.0+/-4.3 in those with asthma and COPD, respectively (p<0.001). The FeNO levels tended to increase along with the disease severity scores by HRCT; however, it was statistically not significant. FeNO in BE with a co-infection of nontuberculous mycobacteria was the lowest at 17.0+/-3.5 ppb among the study population.
CONCLUSION
FeNO in BE was lower than other chronic inflammatory airway diseases, particularly compared with asthma. For clinical application of FeNO in BE, more large-scaled, prospective studies should be considered.

Keyword

Nitric Oxide; Bronchiectasis; Nontuberculous Mycobacteria

MeSH Terms

Asthma
Blood Cell Count
Bronchiectasis
Coinfection
Eosinophils
Humans
Inflammation
Nitric Oxide
Nontuberculous Mycobacteria
Pulmonary Disease, Chronic Obstructive
Retrospective Studies
Spirometry
Sputum
Nitric Oxide

Figure

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  Figure 1 Correlation analysis of fractional exhaled nitric oxide (FeNO) and eosinophil count (A), forced expiratory volume in 1 second (FEV1) (B).

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  Figure 2 Comparison of fractional exhaled nitric oxide (FeNO) levels in the bronchiectasis (BE) and non-BE patients (n=125, all numeric data in the bottom row were showed by mean values±standard errors). In each group, the bottom and top of the box means the 25th and 75th percentile (the lower and upper quartiles, respectively), and the thick line is the median value. The ends of the whiskers (thin lines) represent the lowest datum still within 1.5 interquartile ranges (IQR) of the lower quartile, and the highest datum still within 1.5 IQR of the upper quartile. Blanked circles mean outliers; 139.0 in asthma, 97.0 and 65.0 in chronic obstructive pulmonary disease (COPD), 54.0 and 40.0 in BE without nontuberculous mycobacteria (NTM) infection (BE-NTM), and 45.0 and 39.0 in BE with NTM infection (BE+NTM). *p<0.001, **p<0.05, ***p=0.990.

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  Figure 3 Fractional exhaled nitric oxide (FeNO) and disease severity assessed by high resolution computed tomography (HRCT) in patients with bronchiectasis. Dots represent mean level of FeNO in each group. Dot lines represent the lowest datum still within 1.5 interquartile ranges (IQR) of the lower quartile, and the highest datum still within 1.5 IQR of the upper quartile.

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