title: Alveolar and bronchial exhaled nitric oxide in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Fractional exhaled NO (Fe,NO) has yielded inconsistent results in COPD. Measuring exhaled NO at multiple flow rates however, allows to dissect exhaled NO in an alveolar (CAlv,NO) and bronchial (J'aw,NO) fraction, which are claimed to better reflect the bronchial and alveolar inflammation in COPD. We examined whether the use of Fe,NO, CAlv,NO and J'aw,NO may contribute to the clinical diagnosis of COPD.
  
  
  METHODS
  One hundred and fifty one patients were included in this case-control design: 28 healthy nonsmokers, 39 healthy smokers, 55 COPD nonsmokers and 29 COPD smokers. Prior to spirometry, exhaled NO was measured at three different flow rates (50, 100 and 200 ml/s; NIOX-FLEX) from which Fe,NO, CAlv,NO and J'aw,NO were calculated.
  
  
  RESULTS
  Mean Fe,NO, mean CAlv,NO and mean J'aw,NO of healthy individuals were not significantly different from COPD patients and none of these variables correlated with FEV(1). In both healthy and COPD patients, current smoking significantly reduced Fe,NO, J'aw,NO and CAlv,NO. Multivariate analysis demonstrated that in contrast to gender, age, BMI, GOLD stage and the use of inhaled corticosteroids, current smoking was the only variable affecting CAlv,NO. (p=0.0115)
  
  
  CONCLUSIONS
  We conclude that similar to single breath exhaled NO, exhaled NO at different flow rates does not contribute to the diagnosis of COPD in standard respiratory practice.
authors.affiliation: Respiratory Division, University Hospital Gasthuisberg; Katholieke Universiteit Leuven, Herestraat 49, Bus 706, 3000 Leuven, Belgium. an.lehouck@med.kuleuven.be
authors.forename: An
authors.initials: A
authors.lastname: Lehouck
authors.forename: Claudia
authors.initials: C
authors.lastname: Carremans
authors.forename: Kristien
authors.initials: K
authors.lastname: De Bent
authors.forename: Marc
authors.initials: M
authors.lastname: Decramer
authors.forename: Wim
authors.initials: W
authors.lastname: Janssens
mesh_terms: D000368:Aged; D001530:Belgium; D015415:Biomarkers / Q000378:metabolism; D001980:Bronchi / Q000378:metabolism / Q000503:physiopathology*; D016022:Case-Control Studies; D045853:Exhalation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D011650:Pulmonary Alveoli / Q000378:metabolism / Q000503:physiopathology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D012129:Respiratory Function Tests; D012907:Smoking / Q000378:metabolism / Q000503:physiopathology*
chemical_list: D015415:Biomarkers; D009569:Nitric Oxide