Frank is 65 and has been diagnosed with COPD.
He has a previous smoking history of 25 pack-years. Frank has no allergies, and reports that his breathing difficulties began 5 years ago. He has been on inhaled corticosteroid (ICS) therapy with fluticasone (100 μg twice daily).
Frank is generally compliant with his ICS regimen. He describes his condition as relatively constant, with periods of detoriation during airway infections.
• FEV1 is 42% of expected, with 6% reversibility
• The FENO value is 10 ppb
• Is Frank’s COPD becoming more severe?
• Should he continue taking ICS?
The FENO value indicates that Frank has no ongoing eosinophilic airway inflammation that can respond to steroids.
Current treatment guidelines for COPD entail two separate, lengthy processes for administering ICS: a “trial of steroid”, whereby spirometric improvement is measured at a later date; or an observation of repeated exacerbations over a period of years. Although the FENO is not routinely measured in patients with COPD, evidence suggest it can provide additional information about disease severity, prognosis, and possible response to anti-inflammatory therapy, and may help to determine whether ICS treatment is necessary.
Frank’s doctor tells him to stop taking his ICS medication.
After initially dropping, Frank’s FENO value rises to 15 ppb over the course of 7 weeks. He reports no reoccurence of symptoms.
The modest increase in Frank’s FENO value, after cessation of ICS, coupled with his stable symptoms, suggests that his COPD is well-controlled, and is not severe enough to warrant continuation of ICS therapy.