title: Exhaled nitric oxide dynamics in asthmatic reactions induced by diisocyanates.
abstract: Isocyanate-induced asthmatic reactions are associated with delayed increase in fractional exhaled nitric oxide measured at expiratory flow of 50 mL/s (FeNO50), a biomarker of airway inflammation. The time course of FeNO increase is compatible with the activation of NO synthase, but the origin of NO production in the lung is undetermined.
  
  
  
  The aim of this study was to define the dynamics of airway and alveolar NO during specific inhalation challenge (SIC) with isocyanates and the role of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase.
  
  
  
  Spirometry, exhaled NO parameters (FeNO50, bronchial wall NO concentration, NO airway diffusing capacity, NO flux to luminal space, alveolar NO) and ADMA levels in exhaled breath condensate were measured before and at intervals up to 24 h after exposure to isocyanates. The results were compared between 17 SIC-positive and eight SIC-negative subjects.
  
  
  
  A significant FeNO50 increase in SIC-positive subjects was detected 24 h after exposure and was associated with the augmented NO flux from airway wall to the lumen, whereas airway NO diffusion and alveolar NO were not affected. The changes in NO dynamics were specific for the subjects who developed an asthmatic reaction, but were independent from the pattern and magnitude of bronchoconstriction. There was no evidence that exhaled NO is modulated by the changes in ADMA concentration.
  
  
  
  Because isocyanate-induced increase in FeNO50 was almost exclusively determined by the increase in NO flux, the use of FeNO50 appears adequate to monitor the exhaled NO dynamics during SIC. FeNO50 measurement may provide additional information to spirometry, because bronchoconstriction and airway inflammatory responses are dissociated.
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Mason
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Scarpa
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Guarnieri
authors.affiliation: Women's and Children's Health Department, University of Padova, Padova, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Giordano
authors.affiliation: Women's and Children's Health Department, University of Padova, Padova, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Baraldi
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Maestrelli
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000209:etiology*; D015415:Biomarkers; D001944:Breath Tests; D001985:Bronchial Provocation Tests; D045853:Exhalation; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D017953:Isocyanates / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D017953:Isocyanates; D009569:Nitric Oxide
keywords: airway inflammation; lung function; occupational asthma