PMID- 19661244
OWN - NLM
STAT- MEDLINE
DCOM- 20091201
LR  - 20131121
IS  - 1535-4970 (Electronic)
IS  - 1073-449X (Linking)
VI  - 180
IP  - 9
DP  - 2009 Nov 1
TI  - Predicting corticosteroid response in chronic obstructive pulmonary disease using 
      exhaled nitric oxide.
PG  - 846-52
LID - 10.1164/rccm.200905-0685OC [doi]
AB  - RATIONALE: Predicting corticosteroid response in COPD is important but difficult. 
      Response is more likely to occur in association with eosinophilic airway 
      inflammation, for which the fraction of exhaled nitric oxide (Fe(NO)) is a good 
      surrogate marker. OBJECTIVES: We aimed to establish whether Fe(NO) levels would 
      predict the clinical response to oral corticosteroid in COPD. METHODS: We 
      performed a double-blind, crossover trial of steroid in patients with COPD. After 
      a 4-week washout of inhaled steroids, patients received prednisone 30 mg/d or 
      matching placebo, in random order, with an intervening 4-week washout. The 
      predictive values of Fe(NO) for clinically significant changes in 6-minute-walk 
      distance (6MWD), spirometry (FEV(1)), and St. George's Respiratory Questionnaire 
      (SGRQ) were calculated. MEASUREMENTS AND MAIN RESULTS: A total of 65 patients 
      (mean FEV(1) = 57% predicted) were randomized. With prednisone, there was a net 
      increase of 13 m in 6MWD (P = 0.02) and 0.06 L in postbronchodilator FEV(1) (P = 
      0.02) compared with placebo. The change in SGRQ was not significant. Using 
      receiver operator characteristic analysis, the area under the curve for an 
      increase of 0.2 L in FEV(1) was 0.69 (P = 0.04) with an optimum Fe(NO) cut-point 
      of 50 ppb. The positive and negative predictive values were 67 and 82%, 
      respectively. FE(NO) was not a significant predictor for changes in 6MWD or SGRQ. 
      CONCLUSIONS: Fe(NO) is a weak predictor of short-term response to oral 
      corticosteroid in COPD, its usefulness being limited to predicting increase in 
      FEV(1). Clinical trial registered with www.anzctr.org.au (ACTRN12605000683639).
FAU - Dummer, Jack F
AU  - Dummer JF
AD  - Dunedin and Christchurch Schools of Medicine, University of Otago, Dunedin, New 
      Zealand.
FAU - Epton, Michael J
AU  - Epton MJ
FAU - Cowan, Jan O
AU  - Cowan JO
FAU - Cook, Julie M
AU  - Cook JM
FAU - Condliffe, Robin
AU  - Condliffe R
FAU - Landhuis, C Erik
AU  - Landhuis CE
FAU - Smith, Andrew D
AU  - Smith AD
FAU - Taylor, D Robin
AU  - Taylor DR
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20090806
PL  - United States
TA  - Am J Respir Crit Care Med
JT  - American journal of respiratory and critical care medicine
JID - 9421642
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Anti-Inflammatory Agents)
RN  - 31C4KY9ESH (Nitric Oxide)
RN  - VB0R961HZT (Prednisone)
SB  - IM
CIN - Am J Respir Crit Care Med. 2010 Mar 1;181(5):523-4. PMID: 20185753
MH  - Administration, Oral
MH  - Adrenal Cortex Hormones/metabolism/*therapeutic use
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Inflammatory Agents/metabolism/*therapeutic use
MH  - Cross-Over Studies
MH  - Double-Blind Method
MH  - Exercise Tolerance/drug effects
MH  - *Exhalation
MH  - Female
MH  - Forced Expiratory Volume
MH  - Humans
MH  - Lung/drug effects/metabolism/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Nitric Oxide/*metabolism
MH  - Predictive Value of Tests
MH  - Prednisone/metabolism/*therapeutic use
MH  - Pulmonary Disease, Chronic Obstructive/diagnosis/*drug therapy/metabolism
MH  - Quality of Life
MH  - Respiratory Function Tests
MH  - Treatment Outcome
MH  - Walking
EDAT- 2009/08/08 09:00
MHDA- 2009/12/16 06:00
CRDT- 2009/08/08 09:00
PHST- 2009/08/08 09:00 [entrez]
PHST- 2009/08/08 09:00 [pubmed]
PHST- 2009/12/16 06:00 [medline]
AID - 200905-0685OC [pii]
AID - 10.1164/rccm.200905-0685OC [doi]
PST - ppublish
SO  - Am J Respir Crit Care Med. 2009 Nov 1;180(9):846-52. doi: 
      10.1164/rccm.200905-0685OC. Epub 2009 Aug 6.