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

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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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Acknowledgements

We thank the patients for their participation and all involved technical assistants of the Institute for Prevention and Occupational Medicine (IPA) for their excellent assistance. Authors’ contributions were as follows. Study design: R. Merget, J. Engel, T. Brüning; data collection: J. Engel, R. Merget, O. Hagemeyer, M. Raulf; data analysis: J. Engel, A. Lotz, J. Abramowski, V. Gering; writing: J. Engel, R. Merget, V. van Kampen; data interpretation: J. Engel, R. Merget, V. van Kampen; critical review: A. Lotz, J. Abramowski, V. Gering, O. Hagemeyer, T. Brüning, M. Raulf.

Funding

This research was performed in the IPA which is an institute of the German Social Accident Insurance, but did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

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

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

Authors
  1. Julia Engel
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  2. Vera van Kampen
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  3. Anne Lotz
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  4. Jessica Abramowski
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  5. Vitali Gering
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  6. Olaf Hagemeyer
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  7. Thomas Brüning
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  8. Monika Raulf
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  9. Rolf Merget
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Corresponding author

Correspondence to Rolf Merget.

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Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants for being included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Engel, J., van Kampen, V., Lotz, A. et al. An increase of fractional exhaled nitric oxide after specific inhalation challenge is highly predictive of occupational asthma. Int Arch Occup Environ Health 91, 799–809 (2018). https://doi.org/10.1007/s00420-018-1325-4

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  • DOI: https://doi.org/10.1007/s00420-018-1325-4

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