Exhaled Nitric Oxide Predicts Glucocorticoid Response in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Summary

This study aimed to investigate differences in responses to systemic glucocorticoid therapy among patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and varying fractional exhaled nitric oxide (FeNO) levels. The findings of this research provide a valuable reference for the clinical application of glucocorticoids.

Abstract

This retrospective study evaluated the clinical value of fractional exhaled nitric oxide in predicting glucocorticoid response in patients with acute exacerbations of chronic obstructive pulmonary disease. Based on the critical value of fractional exhaled nitric oxide (FeNO) levels ≥25 ppb at admission, patients were categorized into two groups: the high FeNO group (n = 61) and the low FeNO group (n = 61). All patients received standard basic treatment, which included inhaled corticosteroids (ICS), short-acting β2 receptor agonists (SABA), and short-acting anticholinergic drugs (SAMA). The treatment subgroup was administered additional systemic glucocorticoid therapy. The primary outcomes of this study were improvements in forced expiratory volume in 1 s (FEV₁% pred) and the COPD Assessment Test (CAT) score. Secondary outcomes included changes in the duration of hospital stay and levels of exhaled nitric oxide. Baseline exhaled nitric oxide (FeNO) levels were positively correlated with blood eosinophil counts. In the high-level FeNO group, patients in the treatment group showed significant improvements in lung function, a reduction in the COPD Assessment Test (CAT) score, and lower exhaled nitric oxide levels compared with the control group. Conversely, in the low-level FeNO group, no significant differences were observed between the treatment and control subgroups. These findings indicate that baseline fractional exhaled nitric oxide can identify eosinophilic airway inflammation and predict responsiveness to glucocorticoid therapy, supporting personalized glucocorticoid treatment selection in acute exacerbations of chronic obstructive pulmonary disease. This retrospective study shows that baseline fractional exhaled nitric oxide identifies eosinophilic airway inflammation and predicts glucocorticoid response in acute exacerbations of chronic obstructive pulmonary disease, supporting personalized treatment and reducing hospital stay.

Introduction

Chronic obstructive pulmonary disease (COPD) is a prevalent, preventable, and treatable condition characterized by persistent airflow limitation. Pathological changes can occur in the airways, pulmonary parenchyma, and pulmonary vasculature of patients, including structural and inflammatory alterations. The severity of these changes escalates with the worsening of airflow obstruction. Notably, even after a patient ceases smoking, these changes may persist. In chronic obstructive pulmonary disease (COPD), the inflammatory pathology is characterized by a significant proliferation of macrophages in the distal airways, alveolar tissue, and pulmonary vasculature, accompani....

Protocol

The study protocol was reviewed and approved by the Ethics Committee of Tianshui First People's Hospital (approval number: 2025-054; approval date: October 28, 2025). Given that this is a retrospective study, only anonymized clinical data were used, and no interventions were applied to patients. The informed consent of patients was waived with the approval of the ethics committee.

1. Research object

This study is a single-center, retrospective clinical investigation of 122 patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) who were admitted to the Department of ....

Results

In this study, regression analysis and other multi-factor methods were not used to correct the above factors. The core reason is that the study group has achieved the balance of baseline confounding factors. Such factors have no statistical interference with the study outcome and do not need further correction. The specific basis is as follows:

In this study, 122 patients with AECOPD were divided into high and low FeNO groups (61 cases each) according to FeNO ≥25 ppb. After the statistical tes.......

Discussion

In this study, patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) were treated with a combination of inhaled corticosteroids ICS, SABA, and SAMA. Within this triple therapy, patients were categorized into high and low groups based on baseline FeNO levels, and systemic corticosteroids were added to each subgroup. The aim was to investigate and assess the clinical significance of FeNO in stratifying AECOPD patients, identify potential beneficiaries of corticosteroid therapy, and monitor the.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Automated Hematology Analyzer	Mindray	CAL-8000	Complete blood count including EOS
Automatic biochemical analyzer	Mindray	BS-2800M	Quantification of serum CRP´SAA
Automatic biochemical analyzer	Mindray	CL-8000i	Detection of PCT
Electronic Medical Record System	Zhejiang Heren Technology Co., Ltd.	Hi Assistant	Extraction of patient clinical data
FeNO Analyzer	Weigu Medical	HFWG-F013	Measurement of fractional exhaled nitric oxide
Pulmonary Function Test System	Jaeger	Ganshorn	Assessment of FEV1, FVC, FEV1/FVC