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Marcuccio G, Ambrosino P, Merola C, Manzo F, Motta A, Rea G, Cantone E, Maniscalco M. Clinical Applications of Nasal Nitric Oxide in Allergic Rhinitis: A Review of the Literature. J Clin Med 2023; 12:5081. [PMID: 37568482 PMCID: PMC10420175 DOI: 10.3390/jcm12155081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Allergic rhinitis, a common allergic disease affecting a significant number of individuals worldwide, is observed in 25% of children and 40% of adults, with its highest occurrence between the ages of 20 and 40. Its pathogenesis, like other allergic diseases, involves innate and adaptive immune responses, characterized by immunologic hypersensitivity to environmental substances. This response is mediated by type 2 immunity. Within type 2 allergic diseases, certain molecules have been identified as clinical biomarkers that contribute to diagnosis, prognosis, and therapy monitoring. Among these biomarkers, nitric oxide has shown to play a key role in various physiological and pathological processes, including neurotransmission, immunity, inflammation, regulation of mucus and cilia, inhibition of microorganisms, and tumor cell growth. Therefore, measurement of nasal nitric oxide has been proposed as an objective method for monitoring airway obstruction and inflammation in different settings (community, hospital, rehabilitation) and in various clinical conditions, including upper airways diseases of the nose and paranasal sinuses. The purpose of this review is to analyze the potential mechanisms contributing to the production of nasal nitric oxide in allergic rhinitis and other related health issues. Additionally, this review aims to identify potential implications for future research, treatment strategies, and long-term management of symptoms.
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Affiliation(s)
- Giuseppina Marcuccio
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.M.)
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Directorate of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Claudia Merola
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.M.)
| | - Fabio Manzo
- Fleming Clinical Laboratory, 81020 Casapulla, Italy;
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 00185 Pozzuoli, Italy;
| | - Gaetano Rea
- Department of Radiology, Monaldi Hospital, AO dei Colli, 80131 Naples, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences—ENT Section, University of Naples Federico II, 80138 Naples, Italy;
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.M.)
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
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Zhao C, Qin M, Jin L, Lai J, Wang Y, Liu S, Yu S. Significance of Exhaled Nitric Oxide and Carbon Monoxide in Auxiliary Diagnosis and Evaluation of Allergic Rhinitis. Mediators Inflamm 2022; 2022:2083057. [PMID: 36466157 PMCID: PMC9712024 DOI: 10.1155/2022/2083057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/06/2022] [Accepted: 10/25/2022] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE The concentration of exhaled NO and CO is considered as a candidate marker of respiratory inflammatory disease. This report discusses the exhaled NO and CO in the auxiliary diagnosis and evaluation of allergic rhinitis (AR). METHODS 60 AR patients from October 2017 to March 2019, compared with 30 healthy controls. The severity of AR disease was distinguished by symptom score. Both groups were tested for exhaled nitric oxide through the nose or mouth and exhale carbon monoxide through the mouth. AR patients received glucocorticoid nasal spray for 1 month and were tested again for nNO, eNO, eCO, and symptom score. RESULTS Before treatment, all the nNO, eNO, and eCO of the AR group were higher than the control group. There were differences in the severe and moderate subgroup: severe > moderate > mild. eCO was not significantly different between the mild and control groups. The nNO, eNO, and eCO levels were positively correlated with symptom score. After treatment, nNO decreased significantly in the three subgroups; eNO and eCO in the severe AR group decreased significantly. Drawing the ROC curve, the area under curve (AUC) of nNO is 0.978. The AUC of eNO and eCO was 0.786 and 0.577, respectively. CONCLUSION The nNO, eNO, and eCO in the AR group are higher than healthy people, which positively correlated with the severity of AR symptoms. The detection of nNO, eNO, and eCO can monitor the changes of AR. The detection of nNO level as an indicator of AR auxiliary diagnosis has high accuracy.
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Affiliation(s)
- Chuanliang Zhao
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
- Department of Allergy, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Mali Qin
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
- Department of Allergy, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Ling Jin
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
- Department of Allergy, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Ju Lai
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
- Department of Allergy, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Yang Wang
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
- Department of Allergy, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Shuangxi Liu
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
- Department of Allergy, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Shaoqing Yu
- Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
- Department of Allergy, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
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Lin CW, Huang HY, Chung FT, Lo CY, Huang YC, Wang TW, Yang LY, Pan YB, Chung KF, Wang CH. Emphysema-Predominant COPD Had a Greater 5-Year Mortality and a Worse Annual Decline in Lung Function Than Airway Obstruction-Predominant COPD or Asthma at Initial Same Degree of Airflow Obstruction. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1261. [PMID: 34833478 PMCID: PMC8622286 DOI: 10.3390/medicina57111261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: We studied whether the extent of exertional oxygen desaturation and emphysema could cause greater mortality in COPD and asthma independent of airflow obstruction. Materials and Methods: We performed a 5-year longitudinal observational study in COPD and asthma patients who matched for airflow obstruction severity. All subjects performed a 6-min walk test (6MWT) and high-resolution computed tomography (HRCT) and followed spirometry and oxygen saturation (SpO2) during the 6MWT every 3-6 months. Overall survival was recorded. Cumulative survival curves were performed according to the Kaplan-Meier method and compared with the log-rank test. Results: The COPD group had higher emphysema scores, higher Δinspiratory capacities (ICs) and lower SpO2 during the 6MWT, which showed a greater yearly decline in FEV1 (40.6 mL) and forced vital capacity (FVC) (28 mL) than the asthma group (FEV1, 9.6 mL; FVC, 1.2 mL; p < 0.05). The emphysema-predominant COPD group had an accelerated annual decline in lung function and worse survival. The nadir SpO2 ≤ 80% and a higher emphysema score were the strong risk factors for mortality in COPD patients. Conclusions: The greater structural changes with a higher emphysema score and greater desaturation during the 6MWT in COPD may contribute to worse yearly decline in FEV1 and higher five-year mortality than in asthma patients with a similar airflow obstruction. The lowest SpO2 ≤ 80% during the 6MWT and emphysema-predominant COPD were the strong independent factors for mortality in chronic obstructive airway disease patients.
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Affiliation(s)
- Chang-Wei Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (C.-W.L.); (H.-Y.H.); (F.-T.C.); (C.-Y.L.); (Y.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hung-Yu Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (C.-W.L.); (H.-Y.H.); (F.-T.C.); (C.-Y.L.); (Y.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (C.-W.L.); (H.-Y.H.); (F.-T.C.); (C.-Y.L.); (Y.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chun-Yu Lo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (C.-W.L.); (H.-Y.H.); (F.-T.C.); (C.-Y.L.); (Y.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yu-Chen Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (C.-W.L.); (H.-Y.H.); (F.-T.C.); (C.-Y.L.); (Y.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ting-Wen Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (L.-Y.Y.); (Y.-B.P.)
| | - Yu-Bin Pan
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (L.-Y.Y.); (Y.-B.P.)
| | - Kian Fan Chung
- National Heart & Lung Institute, Imperial College London & Royal Brompton Hospital, London SW3 6LY, UK;
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (C.-W.L.); (H.-Y.H.); (F.-T.C.); (C.-Y.L.); (Y.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Gong S, Pu Y, Xie L, Yang X, Mao H. Fraction of Exhaled Nitric Oxide Is Elevated in Patients With Stable Chronic Obstructive Pulmonary Disease: A Meta-analysis. Am J Med Sci 2020; 360:166-175. [PMID: 32536416 DOI: 10.1016/j.amjms.2020.04.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/10/2020] [Accepted: 04/29/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Fraction of exhaled nitric oxide (FeNO) is a noninvasive indicator of eosinophilic airway inflammation and has been used for the diagnosis and treatment of asthma. The levels of FeNO are controversial in patients with stable chronic obstructive pulmonary disease (COPD). Accordingly, this study aimed to assess FeNO levels in patients with stable COPD. MATERIALS AND METHODS A search of the Medline, Embase, Web of Science, ClinicalTrials.gov and The Cochrane Library databases was performed in August 2019. The literature search was restricted to articles published in English. Studies were included if they reported data addressing FeNO levels in patients with stable COPD and healthy controls. Review Manager version 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was used for meta-analysis. RESULTS A total of 19 studies were included. Analysis revealed that FeNO levels in patients with stable COPD were higher than those in the healthy control group (mean difference [MD] 2.49 [95% confidence interval {CI} 0.99-4.00]; P < 0.05), those in nonsmoking patients with stable COPD were higher than those in the healthy control group (MD 5.04 [95% CI 2.19-7.89]; P < 0.05) and those in smoking patients with stable COPD were not higher than those in the healthy control group (MD 0.30 [95% CI -2.81 to 3.41]; P = 0.85). FeNO measured using a chemiluminescence analyzer in nonsmoking patients with stable COPD was higher than those in the healthy control group (MD 4.84 [95% CI 1.83-7.86]; P < 0.05). CONCLUSIONS Findings suggested that FeNO levels in patients with stable COPD were elevated, and that smokers exhibited decreased levels.
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Affiliation(s)
- Shenglan Gong
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yin Pu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lingli Xie
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoya Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui Mao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Al-Azzawi MA. Pathological association between oxidative stress and chronic obstructive pulmonary disease. Pathology 2020. [DOI: 10.1016/b978-0-12-815972-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mostafavi-Pour-Manshadi SMY, Naderi N, Barrecheguren M, Dehghan A, Bourbeau J. Investigating Fractional Exhaled Nitric Oxide in Chronic Obstructive Pulmonary Disease (COPD) and Asthma-COPD Overlap (ACO): A Scoping Review. COPD 2018; 15:377-391. [PMID: 30067401 DOI: 10.1080/15412555.2018.1485637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is the most common fixed airflow limitation. Individuals may present with the features of both asthma and COPD called asthma-COPD overlap (ACO) with more severity and worse health-related quality of life than COPD or asthma. One of the promising biomarkers that could be used in clinical practice to differentiate ACO from COPD is fractional exhaled nitric oxide (FENO). The role of Fractional exhaled nitric oxide (FENO) in COPD/ACO remains unknown. This scoping review aims to investigate the role of FENO measurement to differentiate COPD from ACO, to anticipate disease severity/progression and treatment response. A structured comprehensive literature search was performed in major databases including Medline, EMBASE, CINAHL, Cochrane Library, Web of Science, and BIOSIS from 2005 onwards. Thirty-eight studies were retrieved. Based on the synthesis of the reviewed literature, six themes emerged. Thirty-four articles covered more than one theme. From which, 24 articles were on modifying factors in FENO measurement, 18 on FENO in COPD compared with healthy subjects, and seven on FENO in ACO compared with COPD, 22 on FENO and disease severity/progression,12 on FENO and biomarkers, and eight on FENO and treatment response. FENO measurement cannot be used alone in the clinical settings of COPD patients. Although FENO level is higher in ACO patients than COPD-only, it is still unclear if there is a FENO cut-off that can be used to make the diagnosis of ACO and/or to guide therapy with inhaled corticosteroids/glucocorticoids in COPD patients.
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Affiliation(s)
| | - Nafiseh Naderi
- a Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre , Montréal , Québec , Canada.,b Division of Experimental Medicine, Department of Medicine , McGill University , Montreal , Québec , Canada
| | | | - Abolfazl Dehghan
- d Department of Medicine , Islamic Azad University-Yazd Branch , Yazd , Iran
| | - Jean Bourbeau
- a Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre , Montréal , Québec , Canada.,b Division of Experimental Medicine, Department of Medicine , McGill University , Montreal , Québec , Canada
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Huang HY, Chou PC, Joa WC, Chen LF, Sheng TF, Lin HC, Yang LY, Pan YB, Chung FT, Wang CH, Kuo HP. Pulmonary rehabilitation coupled with negative pressure ventilation decreases decline in lung function, hospitalizations, and medical cost in COPD: A 5-year study. Medicine (Baltimore) 2016; 95:e5119. [PMID: 27741132 PMCID: PMC5072959 DOI: 10.1097/md.0000000000005119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Pulmonary rehabilitation (PR) brings benefits to patients with chronic obstructive pulmonary disease (COPD). Negative pressure ventilation (NPV) increases ventilation and decreases hyperinflation as well as breathing work in COPD. We evaluated the long-term effects of a hospital-based PR program coupled with NPV support in patients with COPD on clinical outcomes.One hundred twenty-nine patients with COPD were followed up for more than 5 years, with the NPV group (n = 63) receiving the support of NPV (20-30 cm H2O delivery pressure for 60 min) and unsupervised home exercise program of 20 to 30 min daily walk, while the control group (n = 6) only received unsupervised home exercise program. Pulmonary function tests and 6 min walk tests (6MWT) were performed every 3 to 6 months. Emergency room (ER) visits and hospitalization with medical costs were recorded.A significant time-by-group interaction in the yearly decline of forced expiratory volume in 1 s in the control group analyzed by mixed-model repeated-measure analysis was found (P = 0.048). The 6MWT distance of the NPV group was significantly increased during the first 4 years, with the interaction of time and group (P = 0.003), the time alone (P = 0.014), and the quadratic time (P < 0.001) being significant between the 2 groups. ER exacerbations and hospitalizations decreased by 66% (P < 0.0001) and 54% (P < 0.0001) in the NPV group, respectively. Patients on PR program coupled with NPV had a significant reduction of annual medical costs (P = 0.022).Our hospital-based multidisciplinary PR coupled with NPV reduced yearly decline of lung function, exacerbations, and hospitalization rates, and improved walking distance and medical costs in patients with COPD during a 5-year observation.
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Affiliation(s)
- Hung-Yu Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
| | - Pai-Chien Chou
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
| | - Wen-Ching Joa
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
| | - Li-Fei Chen
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
| | - Te-Fang Sheng
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Bin Pan
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
- Correspondence: Chun-Hua Wang, Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei, Taiwan (e-mail: )
| | - Han-Pin Kuo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
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