Joanne is 72-year-old former smoker with COPD. She has no allergies, and is currently being treated with an ICS (beclomethasone).
Despite generally good adherence to her ICS regimen, for the past 2 years Joanne has exhibited a pattern of relatively stable dyspnea (difficult breathing) that deteriorates during airway infections.
• FEV1 is 25% of expected, with 33% reversibility
• The FENO value is 12 ppb
• Is Joanne’s COPD becoming more severe?
• Is her COPD responsive to ICS therapy?
The FENO value indicates Joanne has no ongoing eosinophilic inflammation at present. Many patients with COPD may have been prescribed ICS based on unknown criteria, possibly raising questions about the appropriateness of continuing with such a regimen. In such cases, measurement of the FENO value may help identify patients with severe, unstable COPD, as well as those who are likely to respond to ICS treatment.
Joanne’s doctor tells her to stop taking her inhaled beclomethasone.
Within 2 weeks of discontinuing ICS therapy, Joanne’s FENO value rapidly rises to 60 ppb.
Interpretation
The high FENO value indicate she has ongoing active eosinophilic inflammation that is likely to respond to steroids; a pattern reminiscent of asthma.
The ICS regimen is reinstated, whereupon Joanne´s FENO value gradually decreases to baseline levels over the next 5 weeks.
Checking Joanne´s FENO value revealed she had a case of COPD-eosinophilic related inflammation that appears to respond to ICS therapy.