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Olivieri M, Malerba M, Spiteri G, Torroni L, Biscardo CA, Valenza D, Malinovschi A. Fractional exhaled nitric oxide levels in relation to work-related respiratory burden and sensitization to wheat flour and multigrain in bakers. Clin Transl Allergy 2021; 11:e12018. [PMID: 34708942 PMCID: PMC8694179 DOI: 10.1002/clt2.12018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/25/2021] [Accepted: 03/17/2021] [Indexed: 01/26/2023] Open
Abstract
Background Work‐related lower airway symptoms (WR‐LAS), rhinitis (WRR), and asthma (WRA) are very common among bakers, due to airborne exposure to wheat flour and multigrain. Limited data is available regarding fractional exhaled nitric oxide (FeNO) in bakers in relation to respiratory burden and occupational sensitization in a real‐life situation. Objective To analyze FeNO levels in relation to WRR, WR‐LAS, and WRA with regard to allergic sensitization to occupational allergen in bakers. Methods Cross‐sectional, observational study of 174 bakers employed in traditional small bakeries in the Verona District. Subjects did FeNO measurements, spirometry, methacholine challenge, and skin prick test to common inhalant aeroallergens and bakeries occupational allergens. Results FeNO levels were higher in subjects sensitized to occupational allergens compared with bakers not sensitized to occupational allergens (22.8 ppb (18.9, 27.6) vs. 12.0 ppb (9.9, 14.5), p < 0.05). FeNO levels were higher in bakers with WRR and occupational sensitization (25.4 (20.6, 31.3)) than in bakers with WRR without occupational sensitization compared and bakers without respiratory burden (13.4 (9.6, 18.6) and 11.9 (9.8, 14.5), both p < 0.001). Similar findings were found for WR‐LAS with regard to the same categories (31.2 (24.1, 40.4) vs 13.3 (11.4, 15.6) and 15.3 (8.5, 27.5), p < 0.001 and p = 0.005). Bakers with WRA, with or without occupational allergic sensitization, had higher levels of FeNO than bakers without respiratory burden (both p ≤ 0.001). These findings were consistent after adjustments for gender, age, height, weight, smoking, and sensitization to common inhalant aeroallergens and lung function. Conclusions WRR and lower airway symptoms in bakers sensitized to occupational allergens relate to increased FeNO. Our study suggests that FeNO is associated with work‐related allergic inflammation in occupational sensitized bakers, but future studies are needed to assess how FeNO should be integrated in the diagnostic work‐up of occupational disease in bakers.
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Affiliation(s)
- Mario Olivieri
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Mario Malerba
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Gianluca Spiteri
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lorena Torroni
- Unit of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Carlo Alberto Biscardo
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Dario Valenza
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Andrei Malinovschi
- Department of Medical Sciences Clinical Physiology, Uppsala University, Uppsala, Sweden
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Malerba M, Ragnoli B, Azzolina D, Montuschi P, Radaeli A. Predictive Markers of Bronchial Hyperreactivity in a Large Cohort of Young Adults With Cough Variant Asthma. Front Pharmacol 2021; 12:630334. [PMID: 33953671 PMCID: PMC8089476 DOI: 10.3389/fphar.2021.630334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/25/2021] [Indexed: 12/01/2022] Open
Abstract
Cough variant asthma (CVA), a common asthma phenotype characterized by nonproductive cough and bronchial hyperreactivity (BHR), is usually detected by bronchial provocation tests (BPTs) which are time-consuming, expensive, and unsafe. The primary study objective was to provide proof of concept for the use of fractional exhaled nitric oxide (FENO), eosinophil count percentage in induced sputum (sEOS%), forced expiratory flow between 25 and 75% of forced vital capacity (FEF25–75%) % predicted value, and FEF25–75% z-scores as surrogate markers predicting BHR in young adults with suspected CVA; the secondary objective was to compare the diagnostic performance of the various techniques. Three hundred and ten subjects (median age 24 years) were included in a cross-sectional study. Subjects were characterized as BHR positive (POS) (n = 147) or BHR negative (NEG) (n = 163) according to methacholine BPT. Classification accuracies were expressed as areas under the receiver operator characteristic curves (AUC). Compared with BHR NEG, FEF25–75% % predicted value and FEF25–75% z-scores were lower in the BHR POS group (p < 0.001), whereas FENO (p < 0.001) and sEOS% were higher (p < 0.001). AUC values for detecting BHR were as follows: FENO, 0.98 (SD = 0.02); sEOS%, 0.98 (SD = 0.02); FEF25–75% % pred, 0.93 (SD = 0.05); FEF25–75% z scores, 0.92 (SD = 0.05). Optimal cutoff values (OCV) for BHR prediction were as follows: FENO, 32.7 ppb (sensitivity = 0.93, specificity = 0.96), sEOS%, 3.80% (sensitivity = 0.94, specificity = 0.94), FEF25–75% % predicted value, 80.0% (sensitivity = 0.90, specificity = 0.87), and FEF25–75% z-score, −0.87 (sensitivity = 0.89, specificity = 0.87). Non-invasive/semi-invasive airway inflammatory or small airway functional measures might be used as surrogate markers predicting BHR in young adults with suspected CVA.
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Affiliation(s)
- Mario Malerba
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Respiratory Unit, S. Andrea Hospital, Vercelli, Italy
| | - Beatrice Ragnoli
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Respiratory Unit, S. Andrea Hospital, Vercelli, Italy
| | - Danila Azzolina
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Paolo Montuschi
- Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Roma, Italy
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Demange V, Grzebyk M, Héry M, Massin N, Paris C, Wild P. Longitudinal predictors of bronchial hyperresponsiveness and FEV 1 decline in bakers. Int Arch Occup Environ Health 2021; 94:751-761. [PMID: 33404731 DOI: 10.1007/s00420-020-01628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine long-term predictors of bronchial hyperresponsiveness (BHR) and forced expiratory volume in one second (FEV1) decline. METHODS A longitudinal study in 110 bakers in 4 industrial bakeries and 38 non-exposed workers was conducted at the workplace with a mean of 3.3 visits per subject over a period of 13 years and a mean duration of follow-up of 6 years in bakers and 8 years in non-exposed subjects. A respiratory health questionnaire was administered; occupational allergen skin prick tests, spirometry and a methacholine bronchial challenge test were performed at each visit. In each bakery, full-shift dust samples of the inhalable fraction were obtained in order to assess the exposure of each job assignment. The repeated measurements of BHR and FEV1 were analyzed using mixed effects logistic and linear regression models in subjects seen at least twice. RESULTS BHR, respiratory symptoms and their simultaneous occurrence depended on the duration of exposure. FEV1 significantly decreased with duration of exposure and BHR at a preceding visit. This result persisted when adjusting for the effect of BHR at the current visit. The measured exposure levels were not a significant predictor for any outcome. Occupational sensitization was only a predictor of a decline in FEV1 when duration of exposure was not included. CONCLUSION In flour-exposed industrial bakers, length of exposure and smoking are long-term determinants of BHR and of the decrease in FEV1. BHR at a preceding visit predicted lower FEV1 even when accounting for the effect of BHR at the current visit.
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Affiliation(s)
- Valérie Demange
- Institut National de Recherche et de Sécurité (INRS), Vandœuvre Les Nancy, France.
| | - Michel Grzebyk
- Institut National de Recherche et de Sécurité (INRS), Vandœuvre Les Nancy, France
| | - Michel Héry
- Institut National de Recherche et de Sécurité (INRS), Vandœuvre Les Nancy, France
| | - Nicole Massin
- Institut National de Recherche et de Sécurité (INRS), Vandœuvre Les Nancy, France
| | - Christophe Paris
- CHU de Rennes, Rennes, France.,INSERM U1085-IRSET, Rennes, France
| | - Pascal Wild
- Institut National de Recherche et de Sécurité (INRS), Vandœuvre Les Nancy, France
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Pignatti P, Visca D, Loukides S, Märtson AG, Alffenaar JWC, Migliori GB, Spanevello A. A snapshot of exhaled nitric oxide and asthma characteristics: experience from high to low income countries. Pulmonology 2020; 28:44-58. [PMID: 33358001 DOI: 10.1016/j.pulmoe.2020.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 12/30/2022] Open
Abstract
Nitric oxide is a gas produced in the airways of asthmatic subjects and related to T2 inflammation. It can be measured as fractional nitric oxide (FeNO) in the exhaled air and used as a non-invasive, easy to evaluate, rapid marker. It is now widely used in many settings to determine airway inflammation. The aim of this narrative review is to report relationship between FeNO and the physiopathologic characteristics of asthmatic patients. Factors affecting FeNO levels have also been analysed as well as the impact of corticosteroid, target therapies and rehabilitation programs. Considering the availability of the test, spreading this methodology to low income countries has also been considered as a possibility for evaluating airway inflammation and monitoring adherence to inhaled corticosteroid therapy. PubMed data search has been performed restricted to English language papers. Research was limited to studies in adults unless studies in children were the only ones reported for a particular issue. This revision could be useful to summarize the role of FeNO in relation to asthma characteristics and help in the use of FeNO in different clinical settings particularly in low income countries.
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Affiliation(s)
- Patrizia Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri IRCCS Pavia, Italy.
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy and Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Anne-Grete Märtson
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- Sydney Pharmacy School, University of Sydney, Sydney, New South Wales, Australia; Westmead Hospital, Sydney, Australia; Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy and Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
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Hoffmeyer F, Sucker K, Berresheim H, Monsé C, Jettkant B, Beine A, Raulf M, Bünger J, Brüning T. Impact of Internal and External Factors on EBC-pH and FeNO Changes in Humans Following Challenge with Ethyl Acrylate. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1020:7-16. [PMID: 28236121 DOI: 10.1007/5584_2017_1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acute effects of ethyl acrylate exposure at 5 ppm for 4 h include changes of pH in exhaled breath condensate (EBC-pH) and exhaled nitric oxide (FeNO). So far, few data have been reported for atopic persons or the impact of the exposure conditions on biomarkers, e.g., constant versus variable application of irritants. Nine atopic and eighteen healthy volunteers without bronchial hyperresponsiveness were exposed for 4 h to ethyl acrylate concentrations of 0.05 ppm (sham), 5 ppm (constant concentration), and 0-10 ppm (variable, mean concentration of 5 ppm) in an exposure laboratory. A positive atopic status was defined according to specific IgE concentrations to common inhalant allergens (sx1 ≥ 0.35 kU/L). Biomarker levels were assessed before and after challenge and adjusted for levels after sham exposure (net response). Ethyl acrylate at constant, but not at variable concentrations induced a significant change in the net responses of EBC-pH and FeNO. Concerning FeNO, this could be observed only for atopic persons. The changes of biomarker levels were related to their baseline values. Biomarker responses to challenge with ethyl acrylate may be influenced by the patterns of application as well as baseline airway inflammation and atopic status of the volunteers.
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Affiliation(s)
- F Hoffmeyer
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany.
| | - K Sucker
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - H Berresheim
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - C Monsé
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - B Jettkant
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - A Beine
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - M Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - J Bünger
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - T Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
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Demange V, Zmirou-Navier D, Bohadana A, Wild P. Do airway inflammation and airway responsiveness markers at the start of apprenticeship predict their evolution during initial training? A longitudinal study among apprentice bakers, pastry makers and hairdressers. BMC Pulm Med 2018; 18:113. [PMID: 29996808 PMCID: PMC6042364 DOI: 10.1186/s12890-018-0674-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 06/13/2018] [Indexed: 11/15/2022] Open
Abstract
Background The natural history of airway inflammation and symptoms in occupations at risk of asthma is still not fully understood. We aimed to study the evolution during apprenticeship of inflammation markers, bronchial hyperresponsiveness (BHR) and symptoms in at-risk subgroups as defined from measurements of markers made shortly after the start of training. Methods Respiratory symptoms, FEV1 and airway resistance post-bronchial challenge (MBC) test results, fractional exhaled nitric oxide (FeNO) measurements, and eosinophils in nasal lavage fluid were investigated in apprentice bakers, pastry-makers and hairdressers. Four visits were conducted: at the start of the training and every six months thereafter. Four baseline risk groups were defined, based on, (i) a high level of FeNO (NO), (ii) eosinophils > 1% (Eosino), (iii) a ≥ 15% decrease in FEV1 during the MBC test (HR), and (iv) a ≥ 50% increase in the resistance (Resist). The statistical analysis relied on mixed models. Results At baseline, the inflammation markers were related to the MBC markers. There was no evidence to suggest that the baseline risk groups predict a differential evolution of the airway inflammation and bronchial responsiveness markers, or the asthma-like symptoms considered. The baseline risk groups defined from MBC test predicted the levels of MBC markers. Similarly, the baseline risk groups based on eosinophilic inflammation predicted the levels of markers for eosinophilia. These results were similar in the three training tracks, with the exception of the FeNO levels which were not different according to the Eosino risk group. Twelve possible new asthma cases were identified, only the HR risk group predicted their occurrence. Conclusions Among this young population, at-risk groups based on initial high levels of inflammation markers did not experience any worsening during the follow-up. However, initial BHR predicted consistently high levels of all markers considered and occurrence of possible asthma. Electronic supplementary material The online version of this article (10.1186/s12890-018-0674-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Valérie Demange
- Institut National de Recherche et de Sécurité (INRS), 1 rue du Morvan, 54519, Vandoeuvre-les-Nancy, France.
| | - Denis Zmirou-Navier
- School of Public Health (EHESP), 15 avenue du Professeur Léon-Bernard, 35043, Rennes Cedex, France
| | - Abraham Bohadana
- Pulmonary Institute, Shaare Zedek Medical Center, 12 Baiyt Street, 91031, Jerusalem, Israel
| | - Pascal Wild
- Institut National de Recherche et de Sécurité (INRS), 1 rue du Morvan, 54519, Vandoeuvre-les-Nancy, France
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7
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Coman I, Lemière C. Fractional Exhaled Nitric Oxide (FeNO) in the Screening and Diagnosis Work-Up of Occupational Asthma. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0122-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Malerba M, Radaeli A, Olivini A, Damiani G, Ragnoli B, Sorbello V, Ricciardolo FLM. Association of FEF25-75% Impairment with Bronchial Hyperresponsiveness and Airway Inflammation in Subjects with Asthma-Like Symptoms. Respiration 2016; 91:206-14. [PMID: 26855322 DOI: 10.1159/000443797] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 12/30/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Forced expiratory flow at 25 and 75% of the pulmonary volume (FEF25-75%) might be considered as a marker of early airway obstruction. FEF25-75% impairment might suggest earlier asthma recognition in symptomatic subjects even in the absence of other abnormal spirometry values. OBJECTIVES The study was designed in order to verify whether FEF25-75% impairment in a cohort of subjects with asthma-like symptoms could be associated with the risk of bronchial hyperresponsiveness (BHR) and with airway inflammation expressed as fractional exhaled nitric oxide (FeNO) and eosinophil counts in induced sputum. METHODS Four hundred adults with a history of asthma-like symptoms (10.5% allergic) underwent spirometry, determination of BHR to methacholine (PD20FEV1), FeNO analysis and sputum induction. FEF25-75% <65% of predicted or <-1.64 z-score was considered abnormal. RESULTS All subjects had normal FVC, FEV1 and FEV1/FVC, while FEF25-75% was abnormal in 27.5% of them. FEF25-75% (z-score) was associated with PD20FEV1 (p < 0.001), FeNO (p < 0.001) and sputum eosinophils (p < 0.001). Patients with abnormal FEF25-75% showed higher levels of FeNO and eosinophils in induced sputum than did patients with normal FEF25-75% (p < 0.01 and p < 0.01, respectively). Subjects with abnormal FEF25-75% had an increased probability of being BHR positive (OR = 13.38; 95% CI: 6.7-26.7; p < 0.001). CONCLUSIONS Our data show that abnormal FEF25-75% might be considered an early marker of airflow limitation associated with eosinophilic inflammation and BHR in subjects with asthma-like symptoms, indicating a role for FEF25-75% as a predictive marker of newly diagnosed asthma.
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Affiliation(s)
- Mario Malerba
- Department of Internal Medicine, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
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Nemer M, Sikkeland LIB, Kasem M, Kristensen P, Nijem K, Bjertness E, Skare Ø, Bakke B, Kongerud J, Skogstad M. Airway inflammation and ammonia exposure among female Palestinian hairdressers: a cross-sectional study. Occup Environ Med 2015; 72:428-34. [PMID: 25653315 DOI: 10.1136/oemed-2014-102437] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 01/18/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Little is known about the working conditions and airway inflammation in hairdressers in Palestine. We aimed to investigate if hairdressers in Palestine have a higher level of airway inflammation as compared to a control group. We also assessed the hairdressers' physical working conditions and exposure to ammonia gases at the hair salons. Lastly, we investigated the association between ammonia levels and inflammation markers in the airways and the blood. METHODS Our study participants were 33 non-smoking hairdressers (aged 19-50 years) and 35 non-smoking control subjects (aged 18-49 years). Both groups answered a questionnaire on respiratory symptoms, and performed lung function and exhaled nitric oxide (eNO) tests. Blood and sputum samples were collected from all participants and air concentration levels of ammonia were measured in 13 salons. RESULTS Hairdressers had a higher level of sputum neutrophil count (absolute numbers/mg sputum (median (25th-75th centiles)) compared to controls, 376 (183-980) and 182 (96-358), respectively. Hairdressers also had significantly elevated eNO and blood C reactive protein (CRP) levels compared to the control subjects, controlled for age and body mass index. Exposure measurements showed that the hairdressers in salons with scarce ventilation were exposed to ammonia concentration, ranging from 3 to 61 mg/m(3). CONCLUSIONS Compared to unexposed controls, the hairdressers had signs of neutrophilic airway inflammation, higher eNO levels and higher CRP. The hairdressers were exposed to high concentrations of ammonia from hairdressing chemicals and their working conditions were unsatisfactory.
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Affiliation(s)
- Maysaa Nemer
- Occupational Epidemiology and Biological Research Lab, Department of Biology, Hebron University, Hebron, Palestine Section for Preventive Medicine and Epidemiology, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Liv I B Sikkeland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mayes Kasem
- Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
| | - Petter Kristensen
- Section for Preventive Medicine and Epidemiology, Institute of Health and Society, University of Oslo, Oslo, Norway Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Khaldoun Nijem
- Occupational Epidemiology and Biological Research Lab, Department of Biology, Hebron University, Hebron, Palestine
| | - Espen Bjertness
- Section for Preventive Medicine and Epidemiology, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Øivind Skare
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Berit Bakke
- Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
| | - Johny Kongerud
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Marit Skogstad
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
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Dinh-Xuan AT, Annesi-Maesano I, Berger P, Chambellan A, Chanez P, Chinet T, Degano B, Delclaux C, Demange V, Didier A, Garcia G, Magnan A, Mahut B, Roche N. Contribution of exhaled nitric oxide measurement in airway inflammation assessment in asthma. A position paper from the French Speaking Respiratory Society. Rev Mal Respir 2014; 32:193-215. [PMID: 25704902 DOI: 10.1016/j.rmr.2014.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/27/2014] [Indexed: 01/06/2023]
Abstract
Nitric oxide (NO) is both a gas and a ubiquitous inter- and intracellular messenger with numerous physiological functions. As its synthesis is markedly increased during inflammatory processes, NO can be used as a surrogate marker of acute and/or chronic inflammation. It is possible to quantify fractional concentration of NO in exhaled breath (FENO) to detect airway inflammation, and thus improve the diagnosis of asthma by better characterizing asthmatic patients with eosinophilic bronchial inflammation, and eventually improve the management of targeted asthmatic patients. FENO measurement can therefore be viewed as a new, reproducible and easy to perform pulmonary function test. Measuring FENO is the only non-invasive pulmonary function test allowing (1) detecting, (2) quantifying and (3) monitoring changes in inflammatory processes during the course of various respiratory disorders, including corticosensitive asthma.
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Affiliation(s)
- A T Dinh-Xuan
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Service de physiologie-explorations fonctionnelles, université Paris-Descartes, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - I Annesi-Maesano
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Inserm et université de médecine Pierre-et-Marie-Curie, 75571 Paris cedex 12, France
| | - P Berger
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Centre de recherche cardio-thoracique Inserm U1045, université de Bordeaux, 33076 Bordeaux cedex, France
| | - A Chambellan
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Inserm UMR 1087, institut du thorax, 44007 Nantes cedex, France
| | - P Chanez
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Service de pneumologie, hôpital Nord, chemin des Bourrelly, 13015 Marseille, France
| | - T Chinet
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Service de pneumologie, CHU Ambroise-Paré, 92104 Boulogne, France
| | - B Degano
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Explorations fonctionnelles, hôpital Jean-Minjoz, centre hospitalier régional universitaire, 25000 Besançon, France
| | - C Delclaux
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - V Demange
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Département épidémiologie en entreprise, INRS, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - A Didier
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Service de pneumologie, CHU de Toulouse, 24, chemin de Pouvourville - TSA, 31059 Toulouse cedex 9, France
| | - G Garcia
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Service de physiologie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France
| | - A Magnan
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Inserm UMR 915, institut du thorax, CHU de Nantes, 44007 Nantes cedex, France
| | - B Mahut
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Cabinet de pédiatrie, 4, avenue de la Providence, 92160 Antony, France
| | - N Roche
- Groupe d'experts de la société de pneumologie de langue française sur la mesure du NO expiré dans l'asthme, société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France; Service de pneumologie et soins intensifs respiratoires, Hôtel Dieu, groupe hospitalier Cochin-Broca, 75014 Paris, France
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11
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Jonaid BS, Pronk A, Doekes G, Heederik D. Exhaled nitric oxide in spray painters exposed to isocyanates: effect modification by atopy and smoking. Occup Environ Med 2014; 71:415-22. [PMID: 24683011 DOI: 10.1136/oemed-2013-101672] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Isocyanate asthma is one of the most frequently identified forms of occupational asthma in industrialised countries. The underlying mechanisms have not been clarified. There is only limited information about the relationship between exhaled nitric oxide (eNO) and occupational exposure to isocyanates and asthma. OBJECTIVES To investigate the association between isocyanate exposure and eNO levels in isocyanate-exposed workers and to elucidate whether eNO acts as a marker of airway inflammation controlling for smoking and atopy in an industry-wide survey. METHODS Information on estimated personal isocyanate exposure, measured eNO levels, health effects and sensitisation were analysed in 229 workers from a cross-sectional study. Univariate and multiple regression analyses were used to explore the exposure-response relationships between isocyanate exposure and eNO, stratified by smoking and atopy. RESULTS A marginally significant exposure-response relationship was found between isocyanate exposure and eNO in atopic, non-smokers (p=0.054). eNO was significantly associated with atopy and smoking, bronchial hyper-responsiveness (BHR), work-related conjunctivitis and rhinitis after adjustment for age, gender, atopy and smoking (p<0.05). A borderline significant association was found between eNO and asthma-like symptoms after adjustment for age, gender, atopy and current smoking (p=0.055). In a small group of isocyanate-exposed workers with positive serum-specific immunoglobulin E (IgE) antibodies to hexamethylene diisocyanate (HDI), elevated eNO levels were clearly exposure related. eNO was associated with the positive specific IgG antibodies to HDI in non-atopic, non-smokers (p=0.03). CONCLUSIONS Increased eNO levels may indicate increased airway inflammation in atopic, non-smokers exposed to isocyanates especially at higher levels of isocyanate exposure.
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Affiliation(s)
- Badri Sadat Jonaid
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, The Netherlands
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12
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Abstract
PURPOSE OF REVIEW Because there is sufficient knowledge of its environmental determinants, occupational asthma is a disease that ought to be largely preventable; yet its incidence in many settings remains unacceptably high. Here we review one approach to prevention: the routine use of health surveillance in exposed workforces. RECENT FINDINGS Health surveillance is widely practised but there is little evidence that it is used strategically to reduce disease incidence. There are several barriers to the effective use of its various components, chiefly symptoms questionnaires and spirometry. Cost-benefit analyses may help to increase the uptake of industry-wide workplace interventions. SUMMARY The effective use of health surveillance for occupational asthma continues to be challenging and there remains relatively little published evidence that will encourage those involved to use it more efficiently. Useful advances could be made by greater collaboration between employers, employee organizations, legislators and researchers.
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Occupational exposure to petroleum products and respiratory health: a cross-sectional study from Algeria. J Occup Environ Med 2013; 54:1382-8. [PMID: 23047657 DOI: 10.1097/jom.0b013e31825fa6c9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the possible impact of long-term occupational exposure to hydrocarbons on respiratory health. METHODS Respiratory health was assessed by questionnaires, spirometry, and exhaled nitric oxide in 250 male workers from a company handling and distributing refined petroleum products (exposed) and 250 electricians (controls). Exposure to hydrocarbons was assessed by personal air monitoring. RESULTS Aerial exposure to hydrocarbons was low. Respiratory and nasal symptoms were significantly more frequent among exposed subjects than among controls. Although forced vital capacity and forced expiratory volume in 1 second did not differ, ratio of forced expiratory volume in 1 second to forced vital capacity and maximal expiratory flows were significantly lower in exposed than in control subjects, adjusting for smoking. Exhaled nitric oxide was significantly higher among exposed subjects (30.1 ppb) than among controls (21.6 ppb), adjusting for age and smoking. CONCLUSIONS Even low exposure to petroleum-derived hydrocarbons is associated with more respiratory and nasal symptoms, lower pulmonary function, and airway inflammation.
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Acouetey DS, Zmirou-Navier D, Avogbe PH, Avogbe P, Tossa P, Rémen T, Barbaud A, Cornejo-Garcia JA, Blanca M, Bohadana A, Paris C, Guéant JL, Guéant-Rodriguez RM. Genetic predictors of inflammation in the risk of occupational asthma in young apprentices. Ann Allergy Asthma Immunol 2013; 110:423-428.e5. [PMID: 23706710 DOI: 10.1016/j.anai.2013.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/31/2013] [Accepted: 04/03/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The influence of genetic predictors of inflammation and atopy on occupational asthma in apprentices is not known. OBJECTIVES To assess the influence of genetic polymorphisms of IL4RA, IL13, TNFA, IL1A, and IL5 on the decline of lung function and bronchial hyperresponsiveness in a prospective follow-up study of baker/pastry maker and hairdresser apprentices. METHODS A total of 351 apprentices were included in the study. We performed skin testing, spirometry, fractional exhaled nitric oxide measurement, and methacholine hyperreactivity testing at the initial visit and during and at the end of the 18-month training period. Gene variants of IL4RA, IL13, TNFA, IL1A, and IL5 were determined in DNA from nasal lavage. RESULTS IL13 R130Q/IL4RA S478P or IL13 R130Q//IL4RA Q551R were significant predictors of the decrease of forced expiratory volume and forced vital capacity (P ≤ .006). Genotype GG of TNFAG308A was associated with bronchial hyperresponsiveness in the whole population and in nonatopic individuals (90.63% vs 9.38%; odds ratio, 3.78; 95% confidence interval, 1.10-12.83). TNFA GA and IL5 CC and TNFA GA and IL1A CC were 2 epistatic predictors of exhaled nitrogen monoxide decrease during follow-up (P = .02 and P = .004, respectively). The association with TNFA GA and IL1A CC was the most significant in nonatopic bakers (P < .001). CONCLUSION We evidenced a predicting influence of IL13/IL4RA and TNFA in the early exposure to allergens and irritants that precedes occupational asthma. The significance of the associations in the absence of atopy suggests an influence of the genetics predictors related to inflammatory pathways.
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Affiliation(s)
- Dovi Stéphanie Acouetey
- Nutrition, Genetics and Environment, INSERM-U954, Faculty of Medecine, Vandoeuvre lès Nancy, France
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15
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Jares EJ, Baena-Cagnani CE, Gómez RM. Diagnosis of occupational asthma: an update. Curr Allergy Asthma Rep 2013; 12:221-31. [PMID: 22467203 DOI: 10.1007/s11882-012-0259-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Work-related asthma (WRA) includes patients with sensitizer- and/or irritant-induced asthma in the workplace, as well as patients with preexisting asthma that is worsened by work factors. WRA is underdiagnosed; thus, the diagnosis is critical to prevent disease progression and its potential for morbidity and mortality. The interview is the first diagnostic tool to be used by physicians, and the question, "Does asthma improve away from work?" is of the highest sensitivity. However, history can show numerous false positives, and the relationships between asthma worsening and work should be confirmed by objective methods such as peak expiratory flow (PEF) at and away from work. PEF sensitivity and specificity can be enhanced in combination with nonspecific bronchial hyperresponsiveness to histamine/methacholine (NSBP) before and after 2 weeks at work and a similar period off work. Immunologic testing, especially skin prick test (SPT) or specific IgE, is useful for high molecular weight allergens and some low molecular weight agents. Other immunologic tests, as well as induced sputum, measurement of exhaled nitric oxide, exhaled breath condensate, and specific inhalation challenge (SIC) are methods that contribute to the diagnosis and are typically performed at specialized facilities. A diagnosis of occupational asthma (OA) should no longer be based on a compatible history only but should be confirmed by means of objective testing. SIC is the diagnostic gold standard. When SIC is not available, the combination of PEF measurement, NSBP test , a specific SPT, or specific IgE may be an appropriate alternative in diagnosing OA.
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Affiliation(s)
- Edgardo J Jares
- Immunology and Allergy Unit, Hospital Nacional Alejandro Posadas, Pcia de Buenos Aires, Argentina.
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16
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Induced Sputum, Exhaled Nitric Oxide, and Particles in Exhaled Air in Assessing Airways Inflammation in Occupational Exposures. Clin Chest Med 2012; 33:771-82. [DOI: 10.1016/j.ccm.2012.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Cirillo I, Ricciardolo FLM, Medusei G, Signori A, Ciprandi G. Exhaled nitric oxide may predict bronchial hyperreactivity in patients with allergic rhinitis. Int Arch Allergy Immunol 2012; 160:322-8. [PMID: 23052027 DOI: 10.1159/000341675] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/06/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Nowadays it is possible to assess airway inflammation by measuring the fractional concentration of exhaled nitric oxide (FeNO) during an office visit and there is international consensus on the testing methodology. The aim of this study was to evaluate whether FeNO measurement may be a predictor of bronchial hyperreactivity (BHR) in patients with allergic rhinitis (AR). METHODS Two hundred eleven patients (196 males, median age 28.5 years) suffering from persistent AR were evaluated. Values for bronchial function (FVC, FEV(1), and FEF(25-75)), bronchial provocation tests (methacholine), exhaled nitric oxide (FeNO), a visual analogue scale for nasal and bronchial symptoms, and sensitization were assessed. RESULTS A strong and inverse correlation between FeNO levels and BHR severity was found (r = -0.58). FeNO was a predictive factor for BHR, and 37 ppb was found to be the best cutoff (area under the curve 0.90) to define the presence of BHR in patients with AR. CONCLUSIONS This study highlights the relevance of FeNO as a possible predictive marker for BHR in AR patients and underlines the close link between upper and lower airways. Thus, FeNO measurement could be a useful screening tool in identifying subjects with rhinitis at risk of developing asthma.
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18
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Ochmann U, Nowak D. Berufsbedingte Allergien der Atemwege. ALLERGO JOURNAL 2012. [DOI: 10.1007/s15007-012-0354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kuriakose J, Rosa MJ, Perzanowski M, Miller R. Bronchial nitric oxide flux may be better associated with inducible nitric oxide synthase promoter methylation. Am J Respir Crit Care Med 2012; 185:460-1; author reply 461. [PMID: 22336683 DOI: 10.1164/ajrccm.185.4.460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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20
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Ferreira CM, Chen JL, Li J, Shimomura K, Yang X, Lussier YA, Pinto LH, Solway J. Genetic interactions between chromosomes 11 and 18 contribute to airway hyperresponsiveness in mice. PLoS One 2012; 7:e29579. [PMID: 22253740 PMCID: PMC3254621 DOI: 10.1371/journal.pone.0029579] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 11/30/2011] [Indexed: 01/28/2023] Open
Abstract
We used two-dimensional quantitative trait locus analysis to identify interacting genetic loci that contribute to the native airway constrictor hyperresponsiveness to methacholine that characterizes A/J mice, relative to C57BL/6J mice. We quantified airway responsiveness to intravenous methacholine boluses in eighty-eight (C57BL/6J X A/J) F2 and twenty-seven (A/J X C57BL/6J) F2 mice as well as ten A/J mice and six C57BL/6J mice; all studies were performed in male mice. Mice were genotyped at 384 SNP markers, and from these data two-QTL analyses disclosed one pair of interacting loci on chromosomes 11 and 18; the homozygous A/J genotype at each locus constituted the genetic interaction linked to the hyperresponsive A/J phenotype. Bioinformatic network analysis of potential interactions among proteins encoded by genes in the linked regions disclosed two high priority subnetworks - Myl7, Rock1, Limk2; and Npc1, Npc1l1. Evidence in the literature supports the possibility that either or both networks could contribute to the regulation of airway constrictor responsiveness. Together, these results should stimulate evaluation of the genetic contribution of these networks in the regulation of airway responsiveness in humans.
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Affiliation(s)
- Caroline M. Ferreira
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
- Department of Neurobiology and Physiology, Northwestern University, Evanston, Illinois, United States of America
| | - James L. Chen
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Jianrong Li
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Kazuhiro Shimomura
- Department of Neurobiology and Physiology, Northwestern University, Evanston, Illinois, United States of America
| | - Xinan Yang
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Yves A. Lussier
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Lawrence H. Pinto
- Department of Neurobiology and Physiology, Northwestern University, Evanston, Illinois, United States of America
| | - Julian Solway
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
- * E-mail:
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Current world literature. Curr Opin Allergy Clin Immunol 2011; 11:594-8. [PMID: 22027954 DOI: 10.1097/aci.0b013e32834d9a9f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Shamsah Kazani
- Department of Medicine, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA 02115, USA
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23
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Budinger GRS, Mutlu GM. Update in environmental and occupational medicine 2010. Am J Respir Crit Care Med 2011; 183:1614-9. [PMID: 21693716 DOI: 10.1164/rccm.201103-0467up] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- G R Scott Budinger
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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24
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Taylor DR. Using biomarkers in the assessment of airways disease. J Allergy Clin Immunol 2011; 128:927-34; quiz 935-6. [PMID: 21621830 DOI: 10.1016/j.jaci.2011.03.051] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 03/21/2011] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
Abstract
A biomarker provides a window on underlying disease activity. This is helpful when the pathology, treatment response, or both are heterogeneous or when trying to interpret nonspecific respiratory symptoms in patients with comorbidities. The successful application of a biomarker result is critically dependent on the specific question being addressed and the performance characteristics of the biomarker in relation to that question in the context of pretest probabilities. Negative prediction might be the best way to use a biomarker, such as a D-dimer, pro-brain natriuretic peptide, and exhaled nitric oxide. In this review the role of biomarkers in airways disease (notably induced sputum eosinophils and exhaled nitric oxide) is considered in relation to risk stratification, identification of treatment responders, identification of a clinical phenotype, monitoring of disease, and new drug development.
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Affiliation(s)
- D Robin Taylor
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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Bohadana AB, Hannhart B, Ghezzo H, Teculescu D, Zmirou-Navier D. Exhaled nitric oxide and spirometry in respiratory health surveillance. Occup Med (Lond) 2011; 61:108-14. [PMID: 21285029 DOI: 10.1093/occmed/kqq184] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Exposure to pollutants in bakeries and hairdressing salons can cause airway syndromes varying from bronchial irritation to asthma. Workplace respiratory health surveillance aims to identify possible cases requiring further investigation. AIMS To compare the performance of fractional exhaled nitric oxide (FE(NO)) and spirometry for health surveillance of apprentice bakers (ABs) and apprentice hairdressers (AHDs). Determinants of FE(NO) were also identified. METHODS Symptoms and physician-diagnosed asthma were evaluated by questionnaire. FE(NO) was measured and spirometry was carried out. Subjects with elevated FE(NO) (FE(NO) > upper limit normal), airway obstruction [forced expiratory volume in 1 s (FEV(1))/forced vital capacity (FVC) < 95th percentile] and atopy (history of allergies) were identified. RESULTS A total of 126 apprentices (59 ABs and 67 AHDs) participated. Twenty-nine (23%) apprentices had abnormal tests: 4 had associated high FE(NO) and airway obstruction, while 25 had either high FE(NO) (n = 15) or airway obstruction (n = 10) alone. Compared with ABs (n = 16), AHDs (n = 13) had more asthma (38 versus 0%; P < 0.05) and atopy (62 versus 6%; P < 0.05). There was no difference in symptoms, smoking FE(NO) or airways obstruction. Among 97 subjects with normal tests, no differences existed between ABs (n = 53) and AHDs (n = 44). Average FE(NO) was increased in atopic non-smokers compared with atopic smokers and non-atopic subjects (P < 0.05). Smoking, a history of allergies, FEV(1)/FVC % observed and respiratory symptoms were the main determinants of FE(NO). CONCLUSIONS FE(NO) and spirometry were not overlapping dimensions in ABs and hairdressers, each test contributing unique information on the physiological status of the respiratory system. FE(NO) may provide added information on airway inflammation not provided by spirometry.
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Affiliation(s)
- A B Bohadana
- Department of Environmental Health and Work Health, University of Montreal, Montreal, Quebec H3T 1A8, Canada.
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