, Volume 192, Issue 4, pp 499–504 | Cite as

Exhaled Nitric Oxide Predicts Eosinophilic Airway Inflammation in COPD

  • Kun-Ta Chou
  • Kang-Cheng Su
  • Shiang-Fen Huang
  • Yi-Han Hsiao
  • Ching-Min Tseng
  • Vincent Yi-Fong Su
  • Shih-Chieh Hung
  • Diahn-Warng Perng



Chronic obstructive pulmonary disease (COPD) with eosinophilic airway inflammation may represent a unique phenotype, possibly with shared features of COPD and asthma. The role of exhaled nitric oxide (eNO) in identifying COPD patients with sputum eosinophilia was examined in this study.


Ninety COPD patients without past medical history of asthma or allergic diseases were prospectively enrolled, and their eNO, lung function, and cellular profile of induced sputum were measured. Eosinophil cationic protein and IgE in sputum and venous blood also were determined. Subjects with and without sputum eosinophilia (>3 %) were compared. The role of eNO in the prediction of sputum eosinophilia was assessed in a logistic regression model.


Patients with sputum eosinophilia had significantly higher levels of eNO (29 vs. 18 ppb, p = 0.01) than those without. The difference in serum total IgE (168 vs. 84.9 IU/ml, p = 0.057) and percentages of positive allergen test results (48.3 vs. 29.5 %, p = 0.082) showed a trend toward significance. The sputum eosinophil level was significantly correlated to the eNO level (r = 0.485, p < 0.001). The eNO level at the cutoff of 23.5 ppb had the maximum sum of sensitivity (62.1 %) and specificity (70.5 %). The unadjusted and adjusted odds ratios of a higher eNO level (>23.5 ppb) in the prediction of sputum eosinophilia were 3.909 (confidence interval (CI) 1.542–9.91, p = 0.004) and 4.329 (CI 1.306–14.356, p = 0.017), respectively.


eNO is a good marker to identify COPD patients with eosinophilic airway inflammation.


Chronic obstructive pulmonary disease Eosinophil Nitric oxide 



This work was supported by research Grant CI-100-39 from Yen Tjing Ling Medical Foundation.

Conflict of interest

All the authors declare that there is no potential conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Kun-Ta Chou
    • 1
    • 2
    • 3
    • 4
  • Kang-Cheng Su
    • 1
    • 5
  • Shiang-Fen Huang
    • 1
  • Yi-Han Hsiao
    • 1
  • Ching-Min Tseng
    • 1
  • Vincent Yi-Fong Su
    • 1
  • Shih-Chieh Hung
    • 3
  • Diahn-Warng Perng
    • 1
    • 4
  1. 1.Department of Chest MedicineTaipei Veterans General HospitalTaipeiTaiwan
  2. 2.Center of Sleep MedicineTaipei Veterans General HospitalTaipeiTaiwan
  3. 3.Institute of Clinical MedicineNational Yang-Ming UniversityTaipeiTaiwan
  4. 4.Faculty of Medicine, School of MedicineNational Yang-Ming UniversityTaipeiTaiwan
  5. 5.Institute of Emergency and Critical Care MedicineNational Yang-Ming UniversityTaipeiTaiwan

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