Li Zhang, Mengru Zhang, Alimire Aierken, Ran Dong, Qiang Chen, Zhongmin Qiu
{"title":"肺泡一氧化氮在胃食管反流引起的咳嗽中的作用：前瞻性观察研究。","authors":"Li Zhang, Mengru Zhang, Alimire Aierken, Ran Dong, Qiang Chen, Zhongmin Qiu","doi":"10.1177/17534666241231117","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Fractional exhaled nitric oxide (FeNO) measured at multiple exhalation flow rates can be used as a biomarker to differentiate central and peripheral airway inflammation. However, the role of alveolar nitric oxide (CaNO) indicating peripheral airway inflammation remains unclear in gastroesophageal reflux-associated cough (GERC).</p><p><strong>Objectives: </strong>We aimed to characterize the changes in alveolar nitric oxide (CaNO) and determine its clinical implication in GERC.</p><p><strong>Design: </strong>This is a single-center prospective observational study.</p><p><strong>Methods: </strong>FeNOs at exhalation flow rates of 50 and 200 ml/s were measured in 102 patients with GERC and 134 patients with other causes of chronic cough (non-GERC). CaNO was calculated based on a two-compartment model and the factors associated with CaNO were analyzed. The effect of anti-reflux therapy on CaNO was examined in 26 GERC patients with elevated CaNO.</p><p><strong>Results: </strong>CaNO was significantly elevated in GERC compared with that in non-GERC (4.6 ± 4.4 ppb <i>versus</i> 2.8 ± 2.3 ppb, <i>p</i> < 0.001). GERC patients with high CaNO (>5 ppb) had more proximal reflux events (24 ± 15 <i>versus</i> 9 ± 9 episodes, <i>p</i> = 0.001) and a higher level of pepsin (984.8 ± 492.5 <i>versus</i> 634.5 ± 626.4 pg/ml, <i>p</i> = 0.002) in sputum supernatant than those with normal CaNO. More GERC patients with high CaNO required intensified anti-reflux therapy (χ<sup>2</sup> = 3.963, <i>p</i> = 0.046), as predicted by a sensitivity of 41.7% and specificity of 83.3%. Cough relief paralleled a significant improvement in CaNO (8.3 ± 3.0 <i>versus</i> 4.8 ± 2.6 ppb, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Peripheral airway inflammation can be assessed by CaNO measurement in GERC. High CaNO indicates potential micro-aspiration and may predict a necessity for intensified anti-reflux therapy.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"18 ","pages":"17534666241231117"},"PeriodicalIF":3.3000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898302/pdf/","citationCount":"0","resultStr":"{\"title\":\"Role of alveolar nitric oxide in gastroesophageal reflux-associated cough: prospective observational study.\",\"authors\":\"Li Zhang, Mengru Zhang, Alimire Aierken, Ran Dong, Qiang Chen, Zhongmin Qiu\",\"doi\":\"10.1177/17534666241231117\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Fractional exhaled nitric oxide (FeNO) measured at multiple exhalation flow rates can be used as a biomarker to differentiate central and peripheral airway inflammation. However, the role of alveolar nitric oxide (CaNO) indicating peripheral airway inflammation remains unclear in gastroesophageal reflux-associated cough (GERC).</p><p><strong>Objectives: </strong>We aimed to characterize the changes in alveolar nitric oxide (CaNO) and determine its clinical implication in GERC.</p><p><strong>Design: </strong>This is a single-center prospective observational study.</p><p><strong>Methods: </strong>FeNOs at exhalation flow rates of 50 and 200 ml/s were measured in 102 patients with GERC and 134 patients with other causes of chronic cough (non-GERC). CaNO was calculated based on a two-compartment model and the factors associated with CaNO were analyzed. The effect of anti-reflux therapy on CaNO was examined in 26 GERC patients with elevated CaNO.</p><p><strong>Results: </strong>CaNO was significantly elevated in GERC compared with that in non-GERC (4.6 ± 4.4 ppb <i>versus</i> 2.8 ± 2.3 ppb, <i>p</i> < 0.001). GERC patients with high CaNO (>5 ppb) had more proximal reflux events (24 ± 15 <i>versus</i> 9 ± 9 episodes, <i>p</i> = 0.001) and a higher level of pepsin (984.8 ± 492.5 <i>versus</i> 634.5 ± 626.4 pg/ml, <i>p</i> = 0.002) in sputum supernatant than those with normal CaNO. More GERC patients with high CaNO required intensified anti-reflux therapy (χ<sup>2</sup> = 3.963, <i>p</i> = 0.046), as predicted by a sensitivity of 41.7% and specificity of 83.3%. Cough relief paralleled a significant improvement in CaNO (8.3 ± 3.0 <i>versus</i> 4.8 ± 2.6 ppb, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Peripheral airway inflammation can be assessed by CaNO measurement in GERC. High CaNO indicates potential micro-aspiration and may predict a necessity for intensified anti-reflux therapy.</p>\",\"PeriodicalId\":22884,\"journal\":{\"name\":\"Therapeutic Advances in Respiratory Disease\",\"volume\":\"18 \",\"pages\":\"17534666241231117\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898302/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Therapeutic Advances in Respiratory Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/17534666241231117\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Respiratory Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17534666241231117","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
Role of alveolar nitric oxide in gastroesophageal reflux-associated cough: prospective observational study.
Background: Fractional exhaled nitric oxide (FeNO) measured at multiple exhalation flow rates can be used as a biomarker to differentiate central and peripheral airway inflammation. However, the role of alveolar nitric oxide (CaNO) indicating peripheral airway inflammation remains unclear in gastroesophageal reflux-associated cough (GERC).
Objectives: We aimed to characterize the changes in alveolar nitric oxide (CaNO) and determine its clinical implication in GERC.
Design: This is a single-center prospective observational study.
Methods: FeNOs at exhalation flow rates of 50 and 200 ml/s were measured in 102 patients with GERC and 134 patients with other causes of chronic cough (non-GERC). CaNO was calculated based on a two-compartment model and the factors associated with CaNO were analyzed. The effect of anti-reflux therapy on CaNO was examined in 26 GERC patients with elevated CaNO.
Results: CaNO was significantly elevated in GERC compared with that in non-GERC (4.6 ± 4.4 ppb versus 2.8 ± 2.3 ppb, p < 0.001). GERC patients with high CaNO (>5 ppb) had more proximal reflux events (24 ± 15 versus 9 ± 9 episodes, p = 0.001) and a higher level of pepsin (984.8 ± 492.5 versus 634.5 ± 626.4 pg/ml, p = 0.002) in sputum supernatant than those with normal CaNO. More GERC patients with high CaNO required intensified anti-reflux therapy (χ2 = 3.963, p = 0.046), as predicted by a sensitivity of 41.7% and specificity of 83.3%. Cough relief paralleled a significant improvement in CaNO (8.3 ± 3.0 versus 4.8 ± 2.6 ppb, p < 0.001).
Conclusion: Peripheral airway inflammation can be assessed by CaNO measurement in GERC. High CaNO indicates potential micro-aspiration and may predict a necessity for intensified anti-reflux therapy.
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