Exhaled nitric oxide in specific challenge tests to assess occupational asthma

Piipari, Ritva; Piirilä, Päivi; Keskinen, Helena; Tuppurainen, Matti; Sovijärvi, Anssi; Nordman, Henrik

doi:10.1183/09031936.02.00041802

Cited by 60 publications

(33 citation statements)

References 26 publications

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“…Positive results of SIT were found in 12 bakers, 5 farmers, and 2 HCWs. Statistically significant difference in PC 20 was found in SOAA after SIT ( Table 3). The provocation with allergen did not induce significant changes in FEV 1 and PC 20 in any subject from the control groups.…”

Section: Resultsmentioning

confidence: 98%

“…There are reports indicating that exhaled nitric oxide measurements can give additional information useful for the interpretation of occupational challenge tests [18]. Significant increase in eNO after SIT indicates allergeninduced inflammatory reaction [20]. diagnosed OA at 4 and 24 h after SIT.…”

Section: Discussionmentioning

confidence: 99%

“…We regarded the nasal challenge test positive when the increase in eosinophils proportion persisted for up to 24 h after the provocation and when a two-fold increase in these parameters was observed [14,19]. OA [15] was diagnosed in subjects reporting work-related chest symptoms, for whom SIT was found to induce an early or dual asthmatic reaction (at least a 20% decrease in FEV 1 ) or a three-fold increase in non-specific bronchial hyperactivity (PC 20 ).…”

Section: Methodsmentioning

confidence: 99%

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Exhaled Nitric Oxide Levels After Specific Inahalatory Challenge Test in Subjects with Diagnosed Occupational Asthma

Świerczyńska-Machura¹,

Krakowiak²,

Wiszniewska³

et al. 2008

International Journal of Occupational Medicine and Environmental Health

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Objectives: Measuring exhaled nitric oxide (eNO) is a useful method for the assessment of bronchial inflammation in asthmatic subjects. The aim of the study was to evaluate the changes in eNO level in the subjects with suspected occupational asthma (OA) after a specific inhalation test (SIT) with occupational agents. Materials and Methods: Forty two patients, including 17 farmers, 15 bakers and 10 health care workers had a physical examination, skin prick tests with common and occupational allergens, total serum IgE level, specific anti-allergen IgE determinations, spirometry and SIT. Also, morphological changes in induced sputum (ISP) and nasal lavage fluid (NLF) were analysed and eNO measurements were performed. Results: SIT revealed a significant increase in the proportion of eosinophils in NLF and in ISP in the cases with diagnosed OA. Moreover, these cases showed significantly increased eNO levels only 24 h after SIT, compared to the measurements before SIT. We also found a significant correlation between eNO level at 24 h after SIT and the percentage of eosinophils in NLF before, and 4 and 24 h after SIT, as well as in ISP before and 24 h after SIT in all subjects with diagnosed OA. Conclusion: The findings may confirm the usefulness of exhaled nitric oxide measurements for diagnosing OA.

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Exhaled Nitric Oxide Levels After Specific Inahalatory Challenge Test in Subjects with Diagnosed Occupational Asthma

Świerczyńska-Machura¹,

Krakowiak²,

Wiszniewska³

et al. 2008

International Journal of Occupational Medicine and Environmental Health

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“…There have been conflicting data on the changes in FeNO after SIC with occupational agents [87][88][89][90][91][92][93][94][95]. A significant increase in FeNO level was observed only 24 h after positive challenges, while there was a significant increase in sputum eosinophil at 7 h [92,96].…”

Section: Exhaled Nitric Oxidementioning

confidence: 99%

Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement

et al. 2014

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This consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each step of a SIC, including safety requirements, techniques for delivering agents, and methods for assessing and interpreting bronchial responses. The limitations of the procedure are also discussed.Testing should only be carried out in hospitals where physicians and healthcare professionals have appropriate expertise. Tests should always include a control challenge, a gradual increase of exposure to the suspected agent, and close monitoring of the patient during the challenge and for at least 6 h afterwards. In expert centres, excessive reactions provoked by SIC are rare.A positive response is defined by a fall in forced expiratory volume in 1 s o15% from baseline. Equivocal reactions can sometimes be clarified by finding changes in nonspecific bronchial responsiveness, sputum eosinophils or exhaled nitric oxide. The sensitivity and specificity of SIC are high but not easily quantified, as the method is usually used as the reference standard for the diagnosis of occupational asthma. @ERSpublications ERS Task Force: a statement on specific inhalation challenges in the diagnosis of occupational asthma

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“…Измерение FeNO во время СИПТ может использоваться у пациентов без соответствующих изменений в мокроте [85,86]. Взгляды на изменения FeNO после СИПТ с произ водственными веществами неоднозначны [87][88][89][90][91][92][93][94][95]. Значительное повышение уровня FeNO наблюда лось только через 24 ч после провокационного воз действия, в то время как существенное увеличение эозинофилии мокроты -через 7 ч [92,96].…”

Section: воспаление дыхательных путейunclassified

Challenge inhalation tests in the diagnosis of occupational asthma: the guidelines of European Respiratory Society

Редакционная¹

2015

Pulʹmonologiâ (Mosk.)

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РезюмеВ данном документе содержатся клинические рекомендации по проведению ингаляционных тестов для диагностики профессиональ ной бронхиальной астмы (ПБА). Представленные Рекомендации разработаны на основе систематического обзора литературы, исследо ваний, проводившихся в крупных медицинских центрах Европы, материалов конференций и мнений экспертов. В статье подробно описана пошаговая процедура выполнения специфических ингаляционных провокационных тестов (СИПТ), в т. ч. требования без опасности, способы ингаляционной доставки провоцирующего вещества и методы оценки результатов. Также обсуждаются недостатки этой процедуры. Ингаляционные провокационные тесты должны выполняться только в условиях медицинских учреждений, где имеет ся опыт подобного тестирования. В тестах также должны использоваться контрольные провокационные вещества, доза провоцирующе го вещества должна повышаться постепенно при тщательном наблюдении пациента во время исследования и как минимум в течение 6 ч после его окончания. При соблюдении всех требований побочные эффекты СИПТ встречаются редко. Положительным результатом теста считается снижение объема форсированного выдоха за 1 ю секунду на ≥ 15 %исх. Иногда положительный результат может объяс няться неспецифической бронхиальной гиперреактивностью, эозинофилией мокроты или повышением содержания оксида азота в вы дыхаемом воздухе. Ингаляционные провокационные тесты обладают высокой чувствительностью и специфичностью, поэтому счита ются решающим методом диагностики ПБА. Ключевые слова: специфические ингаляционные провокационные тесты, профессиональная бронхиальная астма, диагностика, методи ка, пиковая скорость выдоха, объем форсированного выдоха за 1 ю секунду. Challenge inhalation tests in the diagnosis of occupational asthma: the guidelines of European Respiratory Society SummaryThis consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each step of a SIC, including safety requirements, techniques for delivering agents, and methods for assessing and interpreting bronchial responses. The limitations of the procedure are also discussed. Testing should only be carried out in hospitals where physicians and healthcare professionals have appropriate expertise. Tests should always include a control challenge, a gradual increase of exposure to the suspected agent, and close moni toring of the patient during the challenge and for at least 6 hours afterwards. In expert centres, excessive reactions provoked by SIC are rare. A pos itive response is defined by a fall in forced expiratory volume in 1 second ≥ 15 % from baseline. Equivocal reactions can sometimes be clarified by finding changes in nonspecific bronchial responsiveness, sputum eosinophils or exhaled nitric oxide. The sensitivity and specificity of SIC are high but not easily quantified, as the method is usually...

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Exhaled nitric oxide in specific challenge tests to assess occupational asthma

Cited by 60 publications

References 26 publications

Exhaled Nitric Oxide Levels After Specific Inahalatory Challenge Test in Subjects with Diagnosed Occupational Asthma

Exhaled Nitric Oxide Levels After Specific Inahalatory Challenge Test in Subjects with Diagnosed Occupational Asthma

Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement

Challenge inhalation tests in the diagnosis of occupational asthma: the guidelines of European Respiratory Society

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