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The Association Between Exhaled Nitric Oxide in Exhaled Breath Condensate and Chronic Obstructive Pulmonary Disease Colin Mitchell Walden University

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The Association Between Exhaled Nitric Oxide in Exhaled Breath Condensate and Chronic Obstructive Pulmonary Disease Colin Mitchell Walden University Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2015 The Association Between Exhaled Nitric Oxide in Exhaled Breath Condensate and Chronic Obstructive Pulmonary Disease Colin Mitchell Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Epidemiology Commons, and the Public Health Education and Promotion Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Colin Mitchell has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Ahmed Arif, Committee Chairperson, Public Health Faculty Dr. Xianbin Li, Committee Member, Public Health Faculty Dr. Kimberly Brownley, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 Abstract The Association Between Exhaled Nitric Oxide in Exhaled Breath Condensate and Chronic Obstructive Pulmonary Disease by Colin Mitchell MBA Marketing, Pace University 2003 BA Biology, University of Delaware, 1992 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University May 2015 Abstract Chronic obstructive pulmonary disease (COPD), a progressive and nonreversible disease, is a leading cause of mortality and morbidity throughout the world. Detecting COPD early in the disease process will help in decreasing later stage COPD severity. Because airway inflammation is a hallmark of COPD, it has been proposed that measuring exhaled nitric oxide, a marker of inflammation, in exhaled breath condensate could prove to be an inexpensive and efficient method to detect COPD in outpatient settings. Using the hypothetico-deductive theory as a guideline, this study used secondary data from the National Health and Nutrition Examination Survey 2007 to 2010 to test the association between exhaled nitric oxide (eNO), COPD, and COPD severity. In addition, this study explored whether occupation modifies the association between eNO and COPD. Descriptive statistics, chi-square analyses, and regression analyses were used to analyze data from a sample size of 10,214 individuals. The prevalence of COPD was 7.2%, based on self-reported physician diagnoses and 11.4% based on prebronchodilator spirometry analysis, strengthening the argument that COPD is often under- or misdiagnosed in clinical settings. This study found no statistically significant association between eNO, COPD, and COPD severity, and occupational status did not appear to modify the association between eNO and COPD. The findings of this study highlight the importance of using objective measures such as spirometry in clinical settings for early diagnosis and management of COPD. Early diagnosis helps to slow the progression of the disease, resulting in fewer related comorbidities and complications. The Association Between Exhaled Nitric Oxide in Exhaled Breath Condensate and Chronic Obstructive Pulmonary Disease by Colin Mitchell MBA Marketing, Pace University 2003 BA Biology, University of Delaware, 1992 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University May 2015 Acknowledgments I would like to take this opportunity to express my gratitude to everyone who provided guidance and support during the dissertation process. First and foremost, I would like to thank my Chair, Dr. Arif Ahmed, for his guidance, insight, and patience. I would like to thank Dr. Xiabin Li and Ms. Alisa Stephens for their statistical support during the dissertation process. To my editor, Mrs. Carrie Crompton, thank you for your guidance. I would like to thank my family, especially my girls Zoe, Kiera, and Alexa for being there throughout the entire process. Last but not least, I could not have done this without the support from my partner, Jennifer Lathrop. Table of Contents List of Tables .......................................................................................................................v List of Figures ................................................................................................................... vii Chapter 1: Introduction to the Study ....................................................................................1 Background of the Study ...............................................................................................1 Problem Statement .........................................................................................................2 Purpose of the Study ......................................................................................................3 Theoretical Framework ..................................................................................................4 Research Questions and Hypotheses .............................................................................5 Definition of Terms........................................................................................................6 Assumptions and Limitations ........................................................................................7 Significance of the Study ...............................................................................................8 Implications for Social Change ......................................................................................9 Summary and Transition ................................................................................................9 Chapter 2: Literature Review .............................................................................................11 Background ..................................................................................................................11 Literature Search Strategy............................................................................................12 Scope of Literature .......................................................................................................14 Theoretical Framework ................................................................................................15 Introduction ..................................................................................................................17 Epidemiology/ Clinical - Demographics .....................................................................22 General Risk Factors ....................................................................................................24 i Symptoms ....................................................................................................................25 Methods for Diagnosis .................................................................................................27 Exhaled Breath Condensate .........................................................................................30 Nitric Oxide: General Overview ..................................................................................33 Nitric Oxide: Association Between COPD and Nitric Oxide ......................................36 Nitric Oxide: COPD and Severity................................................................................38 Occupational Exposure ................................................................................................39 Confounders .................................................................................................................41 Summary ......................................................................................................................43 Chapter 3: Research Method ..............................................................................................44 Introduction ..................................................................................................................44 Research Design and Approach ...................................................................................45 NHANES Data Set .......................................................................................................46 Data Collection ............................................................................................................47 Constructing Weights...................................................................................................48 Sample Size Calculation ..............................................................................................48 Study Variables ............................................................................................................49 Dependent Variables: Chronic Pulmonary Obstructive Disease (COPD) and COPD Severity ................................................................................... 49 Independent Variable: Exhaled Nitric Oxide ........................................................ 50 Effect Modifier: Occupation ................................................................................. 50 Covariate Variables ............................................................................................... 51 ii Variables – Questions and Coding
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