Abstract
BackgroundChronic eosinophilic pneumonia (CEP) is characterized by chronic eosinophilic infiltration of the lung. It is dramatically responsive to corticosteroid treatment, but symptoms and radiopacities recur frequently after tapering or discontinuing the medication. Fractional exhaled nitric oxide (FeNO) is a well-known noninvasive marker of eosinophilic airway inflammation. The aim of this retrospective cohort study was to investigate the relationships of FeNO with peripheral eosinophilia and the clinical state of CEP and its validity for predicting exacerbation of CEP.MethodsStandard clinical and laboratory parameters, peripheral eosinophil percentage and count, and FeNO level were measured in 18 patients with CEP at several assessment points over 1 year.ResultsFeNO level was positively correlated with peripheral eosinophil count (r = 0.341, P = 0.005) and percentage (r = 0.362, P = 0.003). The median (IQR) FeNO levels were 79 (41–88) and 35 (26–49) ppb in uncontrolled (13/74 measurements) and controlled (61/74 measurements) CEP, respectively (P = 0.010). The FeNO level of 66.0 ppb showed the largest area under the curve (0.835) for predicting exacerbation of CEP (sensitivity = 0.80, specificity = 0.84).ConclusionFeNO may be useful for monitoring eosinophilic parenchymal inflammation and determining the appropriate corticosteroid dose in CEP.
Highlights
Chronic eosinophilic pneumonia (CEP) is characterized by chronic eosinophilic infiltration of the lung
We explored the significance of Fractional exhaled nitric oxide (FeNO) in the diagnosis and management of CEP, an eosinophilic lung parenchymal disease, by investigating its relationships with peripheral eosinophilia and the clinical state of CEP and its validity for predicting exacerbation of CEP
In nine of the 10 exacerbation events, FeNO level was measured after corticosteroid administration
Summary
Chronic eosinophilic pneumonia (CEP) is characterized by chronic eosinophilic infiltration of the lung. It is dramatically responsive to corticosteroid treatment, but symptoms and radiopacities recur frequently after tapering or discontinuing the medication. Fractional exhaled nitric oxide (FeNO) is a well-known noninvasive marker of eosinophilic airway inflammation. The aim of this retrospective cohort study was to investigate the relationships of FeNO with peripheral eosinophilia and the clinical state of CEP and its validity for predicting exacerbation of CEP. Chronic eosinophilic pneumonia (CEP) is a rare disease of unknown cause It is characterized by chronic respiratory symptoms, bilateral peripheral lung opacities, pulmonary eosinophilia, and/or peripheral eosinophilia. Symptoms and radiopacities resolve rapidly after corticosteroid treatment [1], but they recur frequently after tapering or discontinuing the medication [1,2]. A marker is required to assist in monitoring and controlling CEP
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