Exhaled Nitric Oxide in Systemic Sclerosis Lung Disease

Natalie K. Kozij¹, John T. Granton², Philip E. Silkoff³, John Thenganatt⁴, Shobha Chakravorty⁴ and Sindhu R. Johnson⁵, ¹Department of Medicine, University Health Network Pulmonary Hypertension Programme, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada., Toronto, ON, Canada, ²Medicine, Univeristiy Health Network Pulmonary Hypertension Programme, Toronto General Hospital and University of Toronto, Toronto, ON, Canada, ³Medicine, Temple University, Philadelphia, PA, ⁴Respirology, University Health Network Pulmonary Hypertension Programme, Toronto, ON, Canada, ⁵Toronto Scleroderma Program, Division of Rheumatology, Toronto Western Hospital, Mount Sinai Hospital, Institue of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: hypertension, Lung Disease, pulmonary fibrosis, scleroderma and systemic sclerosis

Session Information

Date: Monday, November 9, 2015

Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: We evaluated the ability of alveolar and conducting airway nitric oxide (NO) to discriminate between systemic sclerosis (SSc) with and without lung involvement, idiopathic PAH (IPAH), and healthy subjects.

Methods: Consecutive patients in the University Health Network Pulmonary Hypertension Program and Toronto Scleroderma Program were screened. Exhaled nitric oxide was measured at 50, 100, 150, 200 and 250 mL/s using chemiluminescent detection. Alveolar and conducting airway NO were partitioned using a two-compartment model of axial diffusion (CMAD) and the trumpet model of axial diffusion (TMAD).

Results: 60 subjects were recruited: SSc (n=18), SSc-PAH (n=7), SSc-ILD (n=4), SSc-PAH and ILD (n=6), SLE-PAH (n=6), IPAH (n=9) and healthy controls (n=10). Using the CMAD model, healthy subjects had lower median (IQR) alveolar NO than all PAH patients (2.0 ppb (1.5,2.5) versus 3.14 ppb (2.3,4.0), p=0.008). SSc-ILD patients had significantly lower median conducting airway NO compared to controls (1009.5 versus 1342.1 ml*ppb/s, p=0.04). SSc-PAH patients had increased conducting airway NO that inversely correlated with DLCO (Pearson’s r -0.88 (95%CI -0.99, -0.26). Median serum BNP values were higher in SSc-PAH patients than SSc patients without pulmonary involvement (358.8 versus 11.6 pg/ml, p=0.01).

Conclusion: Compartmental exhaled NO measurements vary depending on the type of pulmonary pathology present in individuals with SSc, supporting discriminative validity in SSc lung disease.

Disclosure: N. K. Kozij, None; J. T. Granton, Actelion Pharmaceuticals US, Bayer and GSK, 5,Bayer, Actelion, Pfizer, 9,Actelion and Bayer, 9,Actelion Pharmaceuticals US, 9,IKARIA, 9; P. E. Silkoff, None; J. Thenganatt, Pfizer Inc, Actelion, and Bayer, 9; S. Chakravorty, None; S. R. Johnson, None.

To cite this abstract in AMA style:

Kozij NK, Granton JT, Silkoff PE, Thenganatt J, Chakravorty S, Johnson SR. Exhaled Nitric Oxide in Systemic Sclerosis Lung Disease [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/exhaled-nitric-oxide-in-systemic-sclerosis-lung-disease/. Accessed .

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/exhaled-nitric-oxide-in-systemic-sclerosis-lung-disease/