***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : A subset of patients with chronic obstructive pulmonary disease ( COPD ) may respond more favorably to inhaled corticosteroids ( ICS ) , but no simple method is currently utilized to predict the presence or absence of ICS responses in patients with COPD . We evaluated the ability of exhaled nitric oxide ( FENO ) and serum inflammatory markers ( C-reactive protein [ CRP ] , interleukin-6 [ IL-6 ] , and interleukin-8 [ IL-8 ] ) to independently predict spirometric responses to ICS in patients with COPD . Methods : Among 60 ex-smokers with severe COPD ( mean FEV1 1.07 L , 36 % of predicted ) , we conducted a single-arm , open-label study . Participants spent four weeks free of any ICS , followed by four weeks of ICS use ( fluticasone propionate 500 mcg twice daily ) . FENO , CRP , IL-6 , IL-8 , and pre-bronchodilator spirometry  were measured immediately before and after the four weeks of ICS use . Results : Baseline FENO , CRP , IL-6 , and IL-8 showed no correlations to FEV1 responses to ICS . ICS responders ( increase in FEV1 ≥ 200 mL after four weeks of ICS ) did have significantly higher baseline FENO levels compared with non-responders ( 46.5 parts per billion [ ppb ] vs. 25 ppb , p = 0.028 ) . The receiver operating characteristic curve for FENO to discriminate responders from non-responders had an area under curve of 0.72 . Baseline serum inflammatory markers did not differ between responders and non-responders . Conclusion : In ex-smokers with severe COPD , a measure of local pulmonary inflammation , FENO , may be more closely associated with FEV1 responses to four weeks of ICS than are st and ard markers of systemic inflammation , serum CRP , IL-6 , and BACKGROUND The use of inhaled corticosteroids in mild to moderate COPD is controversial . The aim of this study was to determine whether airway hyperresponsiveness to mannitol might identify patients who are likely to respond to add-on inhaled corticosteroids . METHODS Ninety subjects with mild to moderate COPD were recruited and 68 subsequently r and omized in a double-blind manner to receive inhaled budesonide ( 1,600 μg/d , n = 31 ) or placebo ( n = 37 ) for 3 months . Thirty-eight subjects had airway hyperresponsiveness to mannitol ( 17 received budesonide  , 21 placebo ) . All subjects received tiotropium throughout the study , including 4 weeks before r and omization . Spirometry , quality of life ( St. George Respiratory Question naire ) , degree of dyspnea , airway responsiveness to mannitol , and exhaled nitric oxide were assessed at week 0 ( recruitment ) , week 4 ( baseline prior to r and omization ) , and week 16 ( posttreatment ) . RESULTS Compared with placebo , budesonide was associated with improved quality of life in subjects showing airway hyperresponsiveness to mannitol ( difference of changes in quality of life score between r and omization and study completion , −9.1 ; 95 % CI , −15.8 to −2.3 ; P < .01 ) . Treatment with inhaled budesonide also led to a reduction in airway responsiveness to mannitol compared with placebo ( difference in log10 response-dose ratio , −0.3 ; 95 % CI , −0.6 to −0.04 ; P < .01 ) . However , postr and omization changes in FEV1 % predicted , quality of life , and exhaled nitric oxide showed no difference between budesonide and placebo . CONCLUSIONS In subjects with mild to moderate COPD and airway hyperresponsiveness to mannitol  , quality of life and airway responsiveness improved after treatment with inhaled corticosteroids added to long-acting bronchodilator therapy BACKGROUND The exhaled nitric oxide ( FeNO ) is a non-invasive marker of airway inflammation in asthma . A very recent statement has suggested FeNO as potential outcome in chronic obstructive pulmonary disease ( COPD ) . Recently , a new h and -held FeNO analyzer ( NIOX MINO ) has been developed . PATIENTS AND METHODS We have evaluated the NIOX MINO  in COPD patients and monitored FeNO levels during 1-year assessment in the outpatient setting .  Short-term variability in FeNO was compared using a NIOX MINO and a stationary chemiluminescence analyzer ( NOA , Sensormedics ) in healthy volunteers and COPD patients on two consecutive months . Long-term FeNO variability was assessed on a cohort of 70 COPD out patients measuring FeNO for 1 year . The intra-individual FeNO coefficient of variation ( eNOCoV ) was taken as index FeNO long-term variability . RESULTS In COPD there were no significant differences between NIOX MINO and NOA FeNO values recorded at baseline and 1 month later . Ninety five percent limits of agreement between NIOX MINO and NOA were-2.7 and 1.9ppb with significant reliability ( r=0.96 , p<0.0001 ) . Mean FeNO at baseline was 15.0+/-9.5ppb . Over the 1-year period the overall mean FeNO was 15.5+/-10.1ppb . The long-term eNOCoV was 33.9+/-16.4 % ( range 8.1 - 83.1 % ) , and it was significantly associated with exacerbation rate ( r=0.57 , p<0.0001 ) . CONCLUSION FeNO electrochemical h and -held analyzer is feasible in COPD showing good agreement with stationary chemiluminescence analyzer . COPD patients exhibit a wide range of FeNO levels and a high variability of FeNO over time , which was positively associated with the number of exacerbations BACKGROUND Inhaled corticosteroids ( ICS ) treatment for asthma control is generally focused on lung function and symptoms , but inadequately correlated with airway inflammation . OBJECTIVE To compare asthma control in a group of patients whose treatment was based on fraction of exhaled nitric oxide ( FENO ) and sputum eosinophils ( intervention group ) with a group in whom treatment was based on clinical score ( control group ) . Study design and primary outcome : R and omized parallel-group longitudinal 24-month study including 5 visits every 6 months . A combination of asthma exacerbation rate and symptom score at 24 months was the primary outcome . PARTICIPANTS Fourteen patients with eosinophilic asthma per group were included . RESULTS In the intervention group , exacerbation rate/patient/year was reduced at 12 months ( 0.82 ) ( -73 % ) and , to a greater extent at 24 months ( 0.5 ) ( -84 % ) compared with baseline ( 3.21 , p<0.01 ) . In the control group , a significant reduction in exacerbation rate/patient/year was only observed between month 12 ( 3.0 ) and 24 ( 2.0 , -33 % , p<0.01 ) . At 24 months , exacerbation rate was lower ( -75 % ) in the intervention ( 0.5 ) than in the control group ( 2.0 , p<0.05 ) . Compared with baseline , mean symptom scores at 24 months were reduced in both groups ( intervention group : -72 % ; control group : - 60 % ) , but were lower in the intervention ( 8.1±1.0 , p<0.05 ; -27 % ) than in the control group ( 11±2.6 ) . ICS dose gradually increased in both groups throughout the study , with no between-group differences . CONCLUSION Compared with conventional strategy , longitudinal monitoring of FENO and sputum eosinophils improves eosinophilic asthma control in terms of reduced symptoms and exacerbations without additional increase e in ICS treatment RATIONALE Predicting corticosteroid response in COPD is important but difficult . Response is more likely to occur in association with eosinophilic airway inflammation , for which the fraction of exhaled nitric oxide ( Fe(NO ) ) is a good surrogate marker . OBJECTIVES We aim ed to establish whether Fe(NO ) levels would predict the clinical response to oral corticosteroid in COPD . METHODS We performed a double-blind , crossover trial of steroid in patients with COPD . After a 4-week washout of inhaled steroids , patients received prednisone 30 mg/d or matching placebo , in r and om order , with an intervening 4-week washout . The predictive values of Fe(NO ) for clinical ly significant changes in 6-minute-walk distance ( 6MWD ) , spirometry ( FEV(1 ) ) , and St. George 's Respiratory Question naire ( SGRQ ) were calculated . MEASUREMENTS AND MAIN RESULTS A total of 65 patients ( mean FEV(1 ) = 57 % predicted ) were r and omized . With prednisone , there was a net increase of 13 m in 6MWD ( P = 0.02 ) and 0.06 L in postbronchodilator FEV(1 ) ( P = 0.02 ) compared with placebo . The change in SGRQ was not significant . Using receiver operator characteristic analysis , the area under the curve for an increase of 0.2 L in FEV(1 ) was 0.69 ( P = 0.04 ) with an optimum Fe(NO ) cut-point of 50 ppb . The positive and negative predictive values were 67 and 82 % , respectively . FE(NO ) was not a significant predictor for changes in 6MWD or SGRQ . CONCLUSIONS Fe(NO ) is a weak predictor of short-term response to oral corticosteroid in COPD , its usefulness being limited to predicting increase in FEV(1 ) . Clinical trial registered with www.anzctr.org.au ( ACTRN12605000683639 ) The aim of the study was to evaluate the exhaled nitric oxide ( F(ENO ) ) in clinical ly stable chronic obstructive pulmonary disease ( COPD ) , its relationship to the severity of the disease , pulmonary function , smoking status , reversibility of airflow limitation , and ICS therapy . The study was conducted in 47 patients with COPD and 40 healthy controls .  Flow/volume spirometry and F(ENO ) measurement were performed before and after 2 months of ICS therapy .  F(ENO ) were significantly elevated in current smokers and ex-smoking COPD patients . In both groups of COPD patients inhaled corticosteroids ( ICS ) therapy caused a significant decrease in F(ENO ) without significant changes in FEV1 . A positive correlation between initial F(ENO ) and postbronchodilator FEV1 ( % predicted ) was observed in the group of ex-smoking COPD patients , but not in the currently smoking COPD group . In both groups of COPD patients , the initial level of F(ENO ) correlated with the reversibility of airway obstruction , the increase in postbronchodilator FEV1 and the decrease in F(ENO ) following ICS treatment . F(ENO ) increases in patients with stable COPD . ICS therapy decreased elevated F(ENO ) levels in these patients without statistically significant changes in lung function . The selection of COPD patients with increased F(ENO ) level and partial reversibility of airway obstruction should be helpful in terms of proposed ICS treatment There is controversy about the role of inhaled corticosteroids in chronic obstructive pulmonary disease ( COPD ) . Although they appear to have little impact on airways obstruction or its progression , their use may reduce the frequency and /or severity of exacerbations in a subset of patients . We undertook the following study to determine the impact of inhaled corticosteroid on two noninvasive markers of airways inflammation . We assigned 20 stable nonsmoking patients with COPD in r and om , double-blind crossover fashion to two 2-wk treatment periods with inhaled beclomethasone 500 microg twice daily or matching placebo , followed by a 2-wk washout period . We measured exhaled nitric oxide ( ENO ) , breath condensate H(2)O(2 ) , and flow volume spirometry at weekly intervals . Median baseline ENO was 26.2 ( 19.3 to 54.8 ) ppb and fell significantly following 1 and 2 wk of beclomethasone ( -10.6 ppb , p = 0.002 , and -6.3 ppb , p = 0.013 , respectively ) but was unchanged by placebo inhalation . Breath condensate H(2)O(2 ) levels did not change significantly with inhaled beclomethasone or placebo . Although there were no significant changes in FEV(1 ) with BDP therapy , there was a moderate inverse correlation between changes in ENO and changes in FEV(1 ) ( r -0.50 ) . We conclude that inhaled beclomethasone reduces ENO levels in stable nonsmoking patients with COPD , a finding compatible with an antiinflammatory mechanism of action The use of noninvasive methods of monitoring airway inflammation , such as exhaled nitric oxide ( eNO ) and induced sputum , has been shown to improve asthma monitoring and optimize treatment in adult patients with asthma . There is a lack of comparable data in children . Forty children 
    Output:
    
Our findings indicate that FeNO levels significantly decreased with corticosteroid treatment in ex-smokers with COPD .