الفهرس 
chronic obstructive pulmonary disease
5. management of copdOnly 14 pages are availabe for public view
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Abstract
chronic inflammation is a critical feature of chronic obstructive pulmonary disease, assessing airway inflammation is important for investigating the underlying mechanisms of many lung diseases. yet, these are not measured directly in routine clinical practice because of the difficulties in monitoring inflammation.
therefore, considerable interest has focused on developing novel non-invasive methods to measure pulmonary inflammation through analysis of inflammatory markers in exhaled breath.
we measured the levels of exhaled nitric oxide (no), interleukin-6 (il-6), and hydrogen peroxide (h2o2) in copd patients with chronic obstructive pulmonary disease, in order to study the relation between their levels in the exhaled air and disease severity and their role as useful markers of assessing airway inflammation.
the present study included 45 patients with chronic obstructive pulmonary disease based on the criteria of global initiative for chronic obstructive pulmonary disease as group (a). mean age (51 6). they were classified according to post-bronchodilator fev1 classification into:
1. subgroup a1: consists of 15 mild copd patients (fev1 83% predicted, sd, 2% predicted, fev1 ranging from 80-88% predicted).
2. subgroup a2: consists of 15 moderate copd patients (fev1 66.67% predicted, sd, 5.5% predicted, fev1 range 55 to 75% predicted).
3. subgroup a3: consists of 15 severe copd patients (fev1 42.8% predicted, sd, 5.6% range 30 to 49% predicted).
the study included 20 healthy non-smokers age and sex matched with normal spirometry and served as the control group (group b) mean age (49 8). all the subjects were males.
the primary finding of the study was that there was a highly significant increase in the mean value of exhaled nitric oxide in patients with copd group (a) compared to the control group. it was (19.3 2.3 ppb) in group (a) and (8.2 1.2 ppb) in the control group (b).
as regard hydrogen peroxide we found that there was a highly significant increase in the mean value of exhaled hydrogen peroxide in copd patients (group a) compared to control group (b). it was (0.68 mol/l) in group (a) and (0.10 mol/l) in control group (b).
regarding the level of the exhaled interleukin-6 among studied groups, there was a highly significant increase in the mean value of exhaled interleukin-6 in copd patients group (a) compared to control group (b). it was (5.6 1.2 pg.ml/l) in group (a) and it was (2.6 0. 2 pg.ml/l) in group (b).
there was a highly significant increase in the mean value of exhaled no in moderate copd patients (subgroup a2) as compared to mild copd patients (subgroup a1). it was (18.22.5 ppb) in subgroup (a2) and (13.62.1 ppb), in the subgroup (a1).
there was a highly significant increase in the mean value of exhaled interleukin-6 in moderate copd patients (group a2) as compared to mild copd patients (subgroup a1). it was (4.9±3.3 pg/ml/l) in subgroup (a2) and (3.2±1.1 pg/ml/l), in the subgroup (a1).
there was a highly significant increase in the mean value of exhaled hydrogen peroxide in moderate copd patients (subgroup a2) as compared to mild copd patients (subgroup a1). it was (0.6±0.043 mol/l) in group (a2) and (0.49±0.05 mol/l), in (subgroup a1).
there was a highly significant increase in the mean value of exhaled nitric oxide in subgroup (a3) (severe copd), compared to subgroup (a1) (mild copd). it was (20.2 2.1 ppb) in subgroup (a3) (severe copd), and it was (13.6 2.1 ppb) in subgroup (a1) (mild copd).
there was also a highly significant increase in the value of exhaled hydrogen peroxide in severe copd cases (subgroup a3) compared to mild copd cases (subgroup a1). it was (0.95 mol/l) in severe (subgroup a3) cases and its was (0.41 mol/l) in mild cases (subgroup a1).
there was also a highly significant increase in the mean value of exhaled il-6 in severe copd cases subgroup (a3) compared to mild copd cases subgroup (a1), it was (6.5 1.3 pg.ml/l) in subgroup (a3) and (3.2 1.1 pg.ml/l) in mild cases subgroup (a1).
there was a highly significant increase in the mean value of exhaled no in moderate copd patients (subgroup a2) as compared to control group (b). it was (13.6±2.1 ppb) in subgroup (a2) and (8.1±1.06 ppb), in the control group (b).
there was a highly significant increase in the mean value of exhaled interleukin-6 in mild copd patients (subgroup a1) as compared to control group (b). it was (3.2±1.1 pg/ml/l) in subgroup (a1) and (2.6±0.12 pg/ml/l), in the control group (b).
there was a highly significant increase in the mean value of exhaled hydrogen peroxide in mild copd patients (subgroup a1) as compared to control group (b). it was (0.49±0.05 mol/l) in subgroup (a1) and (0.10±0.098 mol/l), in the control group (b).
there was a significant increase in the mean value of exhaled no in severe copd patients (subgroup a3) as compared to moderate subgroup patients (subgroup a2). it was (20.2±2.1 ppb) in subgroup (a3) and (18.2±2.5 ppb), in the subgroup (a2).
there was a highly significant increase in the mean value of exhaled interleukin-6 in severe copd patients (subgroup a3) as compared to moderate subgroup (subgroup a2). it was (6.5±1.3 pg/ml/l) in subgroup (a3) and (4.9±1.3 pg/ml/l), in moderate copd (subgroup a2).
there was a highly significant increase in the mean value of exhaled hydrogen peroxide in severe copd patients (subgroup a3) as compared to moderate copd patients (subgroup a2). it was (0.95±0.1 mol/l) in subgroup (a3) and (0.6±0.043 mol/l), in moderate copd (subgroup a2).
there was a highly significant increase in the mean value of exhaled no in moderate copd patients (subgroup a2) as compared to control group (group b). it was (18.2±2.5 ppb) in subgroup (a2) and (8.1±1.06 ppb), in the control group (b).
there was a highly significant increase in the mean value of exhaled interleukin-6 in moderate copd patients (subgroup a2) as compared to control group (group b). it was (4.9±1.3 pg/ml/l) in subgroup (a2) and (2.6±0.12 pg/ml/l), in control group (group b).
there was a highly significant increase in the mean value of exhaled hydrogen peroxide in moderate copd patients (subgroup a2) as compared to control group (group b). it was (0.6±0.043 mol/l) in subgroup (a2) and (0.10±0.098 mol/l), in control group (group b).
there was also a highly significant increase in the value of exhaled hydrogen peroxide in severe copd cases (a3) compared to control group (b). it was (0.79 0.117 mol/l) in severe (a3) cases and its was (0.109 0.09 mol/l) in control group (b).
there was also a highly significant increase in the mean value of exhaled il-6 in severe copd cases subgroup (a3) compared to control group (b), it was (6.5 1.3 pg.ml/l) in subgroup (a3) and (2.6 0.12 pg.ml/l) in control group (b).
correlating level of exhaled nitric oxide in copd patients (group a) to the fev1, there was a significant negative correlation between mean value of exhaled nitric oxide and fev1 predicted (r = - 0.95, p<0.05).
the increase in the mean value of exhaled nitric oxide in copd patients significantly correlated to the amounts of cigarettes smoked as assessed by pack/year.
also, there was a significant inverse correlations between value of exhaled hydrogen peroxide and fev1 among copd patients group (a) (r = 0.55, p<0.05).
the increase in the mean value of exhaled hydrogen peroxide was significantly correlated to the increase in amounts of cigarettes smoked as assessed by pack/year (r = 0.61, p<0.05).
an inverse correlation was present between mean value of exhaled il-6 and fev1 in copd patients group (a) (r = -0.94, p<0.05).
the increase in exhaled il-6 was directly correlated to the amounts of cigarettes smoked assessed by pack/year (r = 0.597, p<0.05).