title: Effects of exacerbations and seasonality on exhaled nitric oxide in COPD.
abstract: Exhaled nitric oxide (eNO) appears to be associated with airway inflammation seen in chronic obstructive pulmonary disease (COPD). The present authors studied the effects of exacerbation, season, temperature and pollution on eNO. eNO was measured seasonally and at exacerbations in 79 outpatients suffering from COPD (mean forced expiratory volume in one second=42%). The effects of exacerbation symptoms, physiological and environmental parameters were analysed. Stable eNO levels were correlated positively with arterial oxygen tension. Median levels were found to be lower in smokers (5.3 ppb) than in ex- or nonsmokers (6.8 ppb). Levels were higher during October to December (6.9 ppb) than in April to June (4.6 ppb). Levels were also higher during 68 exacerbations in 38 patients (7.4 ppb) than in stable conditions (5.4 ppb), independent of the effects of smoking. The rise in eNO was greater in exacerbations that were associated with colds, a sore throat or dyspnoea combined with a cold. In conclusion, exhaled nitric oxide levels were higher in colder weather and in the autumn, perhaps related to the increased prevalence of viral infection at this time of year. The levels were lower in more severe chronic obstructive pulmonary disease. Exhaled nitric oxide levels were raised at the onset of exacerbation, particularly in the presence of a cold.
authors.affiliation: Academic Unit of Respiratory Medicine, St. Bartholomew's and Royal London School of Medicine and Dentistry, London, UK. A.Bhowmik@qmul.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Bhowmik
authors.forename: T A R
authors.initials: TA
authors.lastname: Seemungal
authors.forename: G C
authors.initials: GC
authors.lastname: Donaldson
authors.forename: J A
authors.initials: JA
authors.lastname: Wedzicha
mesh_terms: D017677:Age Distribution; D000704:Analysis of Variance; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests; D015331:Cohort Studies; D018450:Disease Progression; D045853:Exhalation; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009569:Nitric Oxide / Q000032:analysis*; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism*; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011653:Pulmonary Diffusing Capacity; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism*; D018570:Risk Assessment; D012621:Seasons; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D009569:Nitric Oxide