Chest
Volume 131, Issue 4, April 2007, Pages 1075-1081
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Original Research
COPD
Normal Bronchial Blood Flow in COPD Is Unaffected by Inhaled Corticosteroids and Correlates With Exhaled Nitric Oxide

https://doi.org/10.1378/chest.06-2154Get rights and content

Background

In COPD patients, there is reduced vascularity and inflammation of the bronchi, which may have opposite effects on bronchial blood flow (QAW). We studied the relationship of QAW with the fraction of exhaled nitric oxide (FENO), which is a potent vasodilator. We also investigated the vascular response to budesonide and a β2-agonist.

Methods

We measured QAW in 17 patients with COPD (mean [± SEM] age, 67 ± 3 years; 10 male patients; mean FEV1, 57 ± 3% predicted; mean FEV1/FVC ratio, 54 ± 4%), all of whom were ex-smokers, and in 16 age-matched nonsmoking volunteers (mean age, 64 ± 4 years) and compared this to FENO. QAW was measured using the acetylene dilution method.

Results

Mean QAW was similar in patients with COPD (34.29 ± 1.09 μL/mL/min) compared to healthy subjects (35.50 ± 1.74 μL/mL/min; p > 0.05) and was not affected by long-term treatment (35.89 ± 1.63 μL/mL/min) or short-term treatment (32.50 ± 1.24 μL/mL/min; p < 0.05) with inhaled budesonide. QAW positively correlated with the diffusion of carbon monoxide (ie, carbon monoxide transfer coefficient: r = 0.74; p < 0.05). FENO levels were mildly elevated in steroid-treated patients (10.89 ± 0.87 parts per billion [ppb]) and untreated patients (9.40 ± 0.86 ppb) compared to the control group (8.22 ± 0.57 ppb; p < 0.05) and were correlated with QAW (r = 0.6; p < 0.05). Ten minutes after the inhalation of 200 μg of albuterol, QAW was more elevated in healthy control subjects (59.33 ± 2.40 μL/mL/min) compared to COPD patients (38.00 ± 0.58 μL/mL/min; p < 0.05), indicating that COPD patients may have a reduced bronchial vascular reactivity.

Conclusions

QAW is normal in COPD patients and is not affected by therapy with inhaled corticosteroids or β2-agonists. In addition, QAW correlates with levels of FENO, which may have a regulatory role.

Section snippets

Patients

All the patients who were enrolled in the study met the Global Initiative for Chronic Obstructive Lung Disease criteria for the diagnosis of COPD19 and had moderate (n = 12) or severe (n = 5) disease severity with a moderate degree of emphysema, as assessed by the carbon monoxide transfer coefficient (Tlco) in 10 patients and CT scan in 4 patients. All of the patients were ex-smokers with a history of smoking equivalent to at least 20 pack-years. Active and passive smokers (ie, smoke exposure

QAW

QAW was not significantly different in patients with COPD (34.29 ± 1.09 μL/mL/min) compared to that in healthy subjects (35.50 ± 1.74 μL/mL/min; p > 0.05). In addition, QAW was not affected by long-term treatment with corticosteroids (treated patients, 35.89 ± 1.63; untreated patients, 32.50 ± 1.24 μL/mL/min; p < 0.05) [Fig 1]. QAW was not correlated with airway obstruction as assessed by FEV1; however, there was a positive correlation with Tlco (r = 0.74; p < 0.05) [see Fig 3, left, A].

Effect of Albuterol

Ten

Discussion

We have demonstrated that patients with COPD have a similar QAW compared to healthy subjects and reduced vascular reactivity. Furthermore, for the first time we found a positive correlation between QAW and FENO. We confirm that patients with COPD have an abnormal bronchial vascular reactivity that is steroid-resistant, and we suggest that treatment with NO may have a role in the regulation of QAW.

QAW was measured using the acetylene dilution method, as previously shown.5 This method is

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    This research was supported by National Heart and Lung Institute, London UK.

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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