A dosagem do óxido nítrico exalado (FeNO) no idoso com doença pulmonar obstrutiva

Abstract

Immunosenescence and aging-related decreases of pulmonary function make the elderly more vulnerable to chronic obstructive pulmonary disease (COPD). The usefulness of measurements of the fraction of exhaled nitric oxide (FeNO) has been well documented in evaluations of asthma inflammatory processes in children and young adults. However, few reports have examined FeNO measurements in elderly patients. The main objective of this descriptive cross-sectional study was to assess the contribution of FeNO measurements in the diagnoses of obstructive pulmonary diseases in 202 elderly out patients of the Hospital Teresinha de Jesus in Juiz de Fora, Brazil. The patients’ clinical symptoms were assessed with the International Study of Asthma and Allergies in Childhood (ISAAC) asthma module for elderly patients and the diagnostic routine for COPD, which was based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Of the 202 patients, 43 were subjected to pulmonary function evaluations (spirometry) and FeNO measurements. The exclusion criteria included class III/IV congestive heart insufficiency, dementia, Parkinson’s disease, cerebral vascular accident sequelae, chronic systemic corticosteroid use, immunodeficiency diseases, contraindications for bronchodilator use, smokers or smokers who had stopped smoking forless than one year, and patient refusal to participate. Of the 202 patients, 34 had asthma (23 definite and 11 probable), 20 fit the criteria for COPD, 13 had asthma-COPD overlap, and 135 did not fit the criteria for obstructive pulmonary disease. Of the 43 who were tested for FeNO, 10 showed altered results (23.2%), and 33 showed normal results (76.7%). The FeNO measurements were significantly increased (p = 0.002) in the patients with definite and probable asthma (29.2 parts per billion) compared withn on asthmatic patients (17.5 parts per billion).These results suggested that elderly patients have a significant incidence of asthma-COPD overlap syndrome and that it is important that this syndrome be diagnosed in this population. In addition, this study showed a significant relationship between FeNO values and asthma symptoms or previous asthma diagnoses in elderly patients.