Abstract
SESSION TITLE: Biomarkers in Obstructive Lung Disease SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2018 07:30 AM - 08:30 AM PURPOSE: Fractional excretion of nitric oxide (FENO) has been utilized in the diagnostic evaluation of patients with respiratory symptoms. New guidelines have recommended FENO as part of the evaluation, and a level of 40 ppb is highly suggestive of asthma even in the absence of obstruction on spirometry. This study examined FENO testing as part of the diagnostic evaluation of military personnel with post-deployment symptoms. METHODS: The STAMPEDE III study is a clinical evaluation of active duty service members with respiratory symptoms following deployment to Southwest Asia. All subjects undergo a comprehensive, standardized pulmonary evaluation to include pulmonary function testing, bronchodilator (BD) response, methacholine challenge testing, impulse oscillometry (IOS), FENO testing, laryngoscopy, bronchoscopy, and cardiopulmonary exercise testing. RESULTS: From the STAMPEDE III cohort, 202 participants completed PFT with bronchodilator response, impulse oscillometry and FENO testing prior to undergoing methacholine challenge testing and other study procedures. None were on pulmonary medications during evaluation. Fourteen (7%) participants had a FENO greater than 40 ppb and 44 (22%) greater than 25 ppb. The cohort was divided into 4 groups: 1) no obstruction with negative BD response/normal IOS (n=96); 2) no obstruction with positive BD/IOS (n=44); 3) obstruction with negative BD/IOS (n=11); or 4) obstruction with a positive BD/IOS (n=51). Mean FENO values were 20.7 ± 13.3, 20.7 ± 11.6, 12.0 ± 1.9, and 29.8 ± 35.5 respectively with p values > 0.05. CONCLUSIONS: In a cohort of active duty service members with respiratory symptoms following deployment, the use of FENO as part of the diagnostic evaluation did help discriminate the etiology of symptoms due to underlying airway hyperreactivity. Further correlation with bronchoprovocation testing and BAL cytology is planned. CLINICAL IMPLICATIONS: Measuring FENO can assist with the diagnosis in young patients with respiratory symptoms concerning for asthma. DISCLOSURES: No relevant relationships by Jess Anderson, source=Web Response My spouse/partner as a Employee relationship with United Health Group Please note: $20001 - $100000 Added 03/05/2018 by Aaron Holley, source=Web Response, value=stock options Research funding relationship with Fisher-Paykel Please note: $20001 - $100000 Added 03/05/2018 by Aaron Holley, source=Web Response, value=Grant/Research Support No relevant relationships by John Hunninghake, source=Web Response Speaker/Speaker's Bureau relationship with Janssen Pharmaceuticals Please note: $1001 - $5000 Added 11/27/2017 by Michael Morris, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Vyaire Medical Please note: $1001 - $5000 Added 11/27/2017 by Michael Morris, source=Web Response, value=Consulting fee No relevant relationships by Christina Murillo, source=Web Response
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