Clinical Features of Chronic Obstructive Pulmonary Disease with High Fractional Exhaled Nitric Oxide

Exploring the Prevalence of Respiratory Failure in Adults Presenting With Acute Exacerbations of Chronic Obstructive Pulmonary Disease

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) poses a significant global health burden and is a leading cause of morbidity and mortality. Acute exacerbations of COPD often lead to respiratory failure, necessitating a thorough understanding of its prevalence. This study aimed to investigate the prevalence of respiratory failure among adult patients experiencing acute exacerbations of COPD.

MATERIALS AND METHODS

A descriptive, cross-sectional study was conducted over a span of seven months at the internal medicine department of Hayatabad Medical Complex, Peshawar. A total of 255 adult patients with acute exacerbations of COPD were included, and their demographic data, as well as arterial blood gas (ABG) analysis results, were collected. The prevalence of respiratory failure was defined by specific arterial blood gas criteria.

RESULTS

The study revealed a notable prevalence of respiratory failure (41.18%) among COPD patients presenting with acute exacerbations. Factors such as older age and male gender were identified as being associated with a heightened risk of respiratory failure.

CONCLUSION

In conclusion, acute exacerbations of COPD predominantly affect middle-aged males (65.5%), with the 51-60 age group being the most impacted. Respiratory failure was present in over 41% of cases. ABG analysis indicated significant acid-base imbalances, hypoxemia, and hypercapnia, with compensatory chronic respiratory acidosis. These findings highlight the need for targeted interventions to manage and prevent COPD exacerbations, especially in middle-aged men.

[Effects of type 2 inflammation on bronchodilator responsiveness of large and small airways in chronic obstructive pulmonary disease]

OBJECTIVE

To investigate the impact of type 2 inflammation markers blood eosinophils (EOS) and fractional exhaled nitric oxide (FeNO) on bronchodilator responsiveness (BDR) in patients with chronic obstructive pulmonary disease (COPD).

METHODS

This study was conducted among 389 patients with an established diagnosis of COPD in our hospital from October, 2019 to October, 2023, who all underwent bronchial dilation test (BDT) of the large and small airways. Based on smoking history, blood EOS, and FeNO, these patients were divided group A (blood EOS < 300/μL + FeNO < 35 ppb + smoking history < 20 pack-years), group B (blood EOS < 300/μL+FeNO < 35 ppb+smoking history ≥20 pack-years), group C (blood EOS ≥300/μL or FeNO≥35 ppb+smoking history ≥20 pack-years), and group D (blood EOS ≥300/μL or FeNO ≥35 ppb+smoking history < 20 pack-years) for analyzing the relationship between clinical indexes and BDR.

RESULTS

BDR evaluation based on forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and maximum mid-expiratory flow (MMEF) yielded consistent results, all showing a younger mean age, higher FeNO levels, and higher blood EOS counts and percentages in patients positive for BDT (P < 0.05). The improvement value and improvement rate of FEV1 were significantly lower in group A than in group D. The improvement value and improvement rate of FEV1 as well as the improvement rate of MMEF were significantly lower in group B than in group D. In the overall patients, age and FeNO were significantly correlated with the improvement value and improvement rate of FEV1 and the improvement rate of MMEF (P < 0.05).

CONCLUSION

Type 2 inflammation markers have different effects on BDR in the large and small airways of COPD patients, and their clinical significance needs further investigation.

An Evidence-Based Review of Application Devices for Nitric Oxide Concentration Determination from Exhaled Air in the Diagnosis of Inflammation and Treatment Monitoring

The measurement of nitric oxide (NO) in exhaled air is used in diagnostics and monitoring the pathologies not only in the respiratory system but also in the oral cavity. It has shown a huge increase in its level in asthma and diseases of the oral cavity. It seems reasonable to undertake research on the impact of inflammation on the level of NO in exhaled air. The aim of the study is to make an evidence-based review of the application of NO levels in exhaled air in the diagnosis of inflammation and treatment monitoring on the basis of selected measuring devices.

METHODS AND RESULTS

This paper presents an example of the application of NO measurement in exhaled air in individual human systems. Selected measuring devices, their non-invasiveness, and their advantages are described.

DISCUSSION

The usefulness of this diagnostic method in pathologies of the oral cavity was noted.

CONCLUSIONS

Measuring the level of NO in exhaled air seems to be a useful diagnostic method.