Fractional exhaled nitric oxide in the interpretation of specific inhalational challenge tests for occupational asthma.
OBJECTIVE
Fractional exhaled nitric oxide (FENO) measurements are recommended for the assessment of eosinophilic airway inflammation in asthma. Clinically relevant increases in FENO have been reported 24 h after positive specific inhalational challenge (SIC) tests in occupational asthma. We aimed to determine whether positive SICs could be discriminated from control tests, on the basis of change in FENO.


METHODS
We reviewed all positive SICs to a variety of agents performed at our institution 2008-2012 and gathered data on age, sex, asthmatic response (immediate/dual/late), smoking status, inhaled corticosteroid usage, and FENO pre- and 24-h postcontrol and positive SIC from each worker. Changes in FENO after positive SICs were compared with control SICs from each worker, by using paired Student's t tests.


RESULTS
In 16 workers, negative control challenges were associated with mean changes in FENO of 9 % (95 % CI -1.14 to 19.01) or 1.1 ppb (95 % CI -3.59 to 5.84); 2 of 16 (13 %) workers tested showed increases in FENO that were clinically relevant based on recent guidelines. Subsequent positive SICs were associated with mean changes in FENO of 7 % (95 % CI −15.73 to 29.6) or 2.1 ppb (95 % CI -6.07 to 10.19), which were not significantly different to controls; only 2 of 16 (13 %) workers had FENO changes that were clinically relevant.


CONCLUSIONS
FENO changes above the upper confidence limits of ≥20 % or ≥6 ppb may be considered to be outside the range of normality. However, the majority of workers who had clearly positive SICs to common low molecular weight agents also had no statistically or clinically relevant increase in FENO. Therefore, change in FENO does not predict a positive SIC in this group.
Gareth I
GI
Walters
Vicky C
VC
Moore
Emmet E
EE
McGrath
Sherwood
S
Burge
D000328:Adult; D000395:Air Pollutants, Occupational; D059366:Asthma, Occupational / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D015415:Biomarkers / Q000378:metabolism; D001944:Breath Tests; D001985:Bronchial Provocation Tests / Q000592:standards; D016022:Case-Control Studies; D045853:Exhalation; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D019570:Inhalation Exposure; D008168:Lung / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D016272:Occupational Health; D011237:Predictive Value of Tests; D013147:Spirometry
D000395:Air Pollutants, Occupational; D015415:Biomarkers; D009569:Nitric Oxide