Am. J. Respir. Crit. Care Med., Volume 162, Number 2, August 2000, 446-450

Production of Endogenous Nitric Oxide in Chronic Obstructive Pulmonary Disease and Patients with Cor Pulmonale
Correlates with Echo-Doppler Assessment

ENRICO CLINI, GEORGE CREMONA, MARCO CAMPANA, CARLA SCOTTI, MARCO PAGANI, LUCA BIANCHI, AMERIGO GIORDANO, and NICOLINO AMBROSINO

Fondazione Salvatore Maugeri IRCCS, Division of Respiratory Medicine and Lung Function Unit and Division of Cardiology, Medical Center of Gussago, Gussago (BS), and Unit of Respiratory Medicine, San Raffaele Scientific Institute, Milan, Italy

Exhaled nitric oxide (NO) production in stable chronic obstructive pulmonary disease (COPD) has been loosely related to the severity of illness, being significantly reduced in the most severe cases. Pulmonary hypertension is associated with lower NO output from the lung. In this study expired NO was measured in patients with severe stable COPD with or without cor pulmonale (CP). Echocardiographic estimates of right heart function, lung function, diffusion capacity, respiratory muscle strength, and arterial blood gases were obtained in 34 consecutive patients with stable COPD (mean age, 68 ± 7 yr). Expired NO was measured by chemiluminiscence to obtain fractional exhaled concentrations at peak (FENOp) and at plateau (FENOpl) points of the single-breath curve and resting NO output ( NO). All measurements of expired NO output, FENOp, FENOpl and NO showed a negative correlation with both systolic pulmonary artery pressure (Pspa) (r = 0.51, 0.63, and 0.63, respectively, p < 0.01 for all) and right ventricle wall dimension (r = 0.41, 0.59, and 0.43, respectively, p < 0.05 for all), but not with any measurement of lung function. When the patients were divided according to the Pspa using a cutoff limit of 35 mm Hg, those subjects with CP showed lower FENOp (13.2 ± 4.0 versus 36.7 ± 30.8 ppb, p < 0.05), FENOpl (5.7 ± 1.9 versus 8.9 ± 4.7 ppb, p < 0.05), and NO (69.2 ± 5.6 versus 107.6 ± 14.6 nl/ min, p = 0.02) than did those with a normal resting Pspa. NO production from the airways was significantly lower and inversely related to development of CP in patients with severe COPD. Impaired endothelial release may account for the reduced levels of expired NO.

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