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Exhaled nitric oxide in specific inhalation challenge.

S Ewald-Kleimeier¹, A Lotz, R Merget

¹Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.

Advances in Experimental Medicine and Biology

|July 10, 2013

Summary

Measurements of exhaled nitric oxide (eNO) after specific inhalation testing (SIT) can help diagnose occupational asthma. Elevated eNO levels 20-22 hours post-SIT indicate an allergic response, especially when combined with other factors like isocyanate exposure.

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Area of Science:

Pulmonary Medicine
Allergy and Immunology
Occupational Health

Background:

Exhaled nitric oxide (eNO) is a biomarker for airway inflammation.
Increased eNO post-specific inhalation testing (SIT) suggests occupational asthma, but interpretation is complex due to confounding factors.
Understanding eNO dynamics after SIT is crucial for accurate diagnosis.

Purpose of the Study:

To investigate the utility of exhaled nitric oxide (eNO) measurements following specific inhalation testing (SIT) in diagnosing occupational asthma.
To identify factors influencing eNO levels in individuals with suspected occupational asthma.

Main Methods:

A cohort of 77 individuals (24 women, 43 men) with suspected occupational asthma underwent comprehensive assessment.
Methods included questionnaires, physical exams, laboratory tests, skin prick testing, lung function tests (including methacholine challenge), and SIT with occupational allergens.
Exhaled nitric oxide (eNO) was measured at baseline (t0), 2 hours (t1), and 20-22 hours (t2) post-SIT.

Main Results:

Baseline eNO was lower in smokers than non-smokers and in non-atopic than atopic individuals (significant in non-responders).
In SIT non-responders (n=45), eNO levels remained unchanged post-SIT.
In SIT responders (n=22), eNO levels significantly increased at t2 (20-22 hours post-SIT).
Factors associated with increased eNO included positive SIT responder status, later measurement time, absence of atopy, and isocyanate exposure.

Conclusions:

Exhaled nitric oxide (eNO) measurements, particularly 20-22 hours after SIT, can provide valuable information regarding a patient's allergenic status in suspected occupational asthma.
The combination of SIT responder status, measurement timing, atopy, and specific allergen exposure (e.g., isocyanates) aids in interpreting eNO levels.
eNO monitoring post-SIT shows promise as a diagnostic tool for occupational asthma.