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International Archives of Occupational and Environmental Health

Published in:

01-10-2018 | Original Article

An increase of fractional exhaled nitric oxide after specific inhalation challenge is highly predictive of occupational asthma

Authors: Julia Engel, Vera van Kampen, Anne Lotz, Jessica Abramowski, Vitali Gering, Olaf Hagemeyer, Thomas Brüning, Monika Raulf, Rolf Merget

Published in: International Archives of Occupational and Environmental Health | Issue 7/2018

Abstract

Purpose

An increase of fractional exhaled nitric oxide (FeNO) has been described after specific inhalation challenges (SICs) with occupational allergens, but the clinical role of FeNO measurements before and after SIC is unknown. It was the aim of this study to assess the diagnostic accuracy of FeNO measurements before and after SIC in subjects with suspected occupational asthma (OA).

Methods

One hundred forty-eight patients with suspected OA were examined by SIC with various occupational allergens. Subjects were assigned to pulmonary responders, nonresponders or doubtful by standard lung function criteria. FeNO was measured before SIC (baseline) and 24 h afterwards. Subjects with negative or doubtful SIC but increase of FeNO were evaluated individually by an overall expert rating. Effect modifiers of FeNO increases were assessed by regression analyses.

Results

Thirty-one patients (21%) were classified as pulmonary responders, 105 (71%) as nonresponders and 12 (8%) as doubtful. With the pulmonary responder status as gold standard an increase of FeNO ≥ 13 ppb showed a specificity of 0.9 and a sensitivity of 0.5. Seventeen subjects with negative or doubtful responder status showed such an increase of FeNO, among them 13 subjects with definitive or probable OA after expert rating. Regression analyses revealed no significant modifiers for the FeNO increase.

Conclusion

An increase of FeNO after SIC is highly predictive of OA and should be regarded as an additional criterion for the interpretation of SIC with occupational agents.

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Title: An increase of fractional exhaled nitric oxide after specific inhalation challenge is highly predictive of occupational asthma
Authors: Julia Engel
Vera van Kampen
Anne Lotz
Jessica Abramowski
Vitali Gering
Olaf Hagemeyer
Thomas Brüning
Monika Raulf
Rolf Merget
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: International Archives of Occupational and Environmental Health / Issue 7/2018
Print ISSN: 0340-0131
Electronic ISSN: 1432-1246
DOI: https://doi.org/10.1007/s00420-018-1325-4

At a glance: The STEP trials

Springer Medicine

An increase of fractional exhaled nitric oxide after specific inhalation challenge is highly predictive of occupational asthma

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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