Occupational Asthma Reference

Lemiere C, D'Alpaos V, Chaboillez S, Cesar M, Wattiez M, Chiry S, Vandenplas O, Investigation of occupational asthma: sputum cell counts or exhaled nitric oxide?., Chest, 2010;137:617-622,

Keywords: Canada, Belgium, induced sputum, nitric oxide, challenge

Known Authors

Olivier Vandenplas, Universite Mont-Goginne, Yvoir Olivier Vandenplas

Catherine Lemière, Hôpital de Sacré Coeur, Montreal, Quebec, Canada Catherine Lemière

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Abstract

BACKGROUND
The measure of sputum eosinophil counts is a useful tool in the investigation of occupational asthma (OA), but processing sputum is time consuming. Measuring the fractional concentration of exhaled nitric oxide (FENO) may be an alternative in clinical practice. The aim of this study was to assess the respective changes of sputum eosinophil counts and FENO following exposure to occupational agents in the routine practice of two tertiary centers in North America and Europe.

METHODS
Workers undergoing specific inhalation challenges (SICs) for possible OA in tertiary clinics in both Canada and Belgium were enrolled. Sputum cell counts and FENO were collected at the end of the control day and at 7 and 24 h after exposure to the offending agent.

RESULTS
Forty-one subjects had a negative SIC; 26 subjects had OA proven by a positive SIC. In subjects with positive SIC, there was a significant increase in sputum eosinophils at 7 h (9.0 [9.9]%) and 24 h (11.9 [14.9]%) after exposure compared with the baseline (2.8 [4.2]%), whereas there was a significant increase in FENO only 24 h after exposure (26.0 [30.5] ppb) compared with the baseline (16.6 [18.5] ppb). A 2.2% change in sputum eosinophil counts achieved a much higher sensitivity and positive predictive value than a 10-ppb change in FENO with similar specificity and negative predictive value for predicting a 20% decrease in FEV(1) during SICs.

CONCLUSIONS
Sputum eosinophil counts constitute a more reliable tool than FENO to discriminate positive and negative SICs.

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Associated Questions

Registered users of this website have associated this reference with the following questions. This association is not a part of the BOHRF occupational asthma guidelines.

What is the use of induced sputum eosinophilia in the diagnosis of occupational asthma
burgeps A 2.2% increase in sputum eosinohils post challenge was seen in 16/20 challenge positive workers and 3/16 challenge negatives. Not affected by maintenance inhaled corticosteroids. This was a post hoc analysis
What is the role of exhaled breath Nitric Oxide in the diagnosis and management of occupational asthma.
burgeps The effects of inhaled corticosteroids on FeNO levels appeared to be gone 72 hours after the last dose. There was no increase 7 hours post challenge, an increase >10ppb seen in 6/16 challenge positive workers at 24 hours. FeNO did not contribute to the interpretation of the challenge in this post hoc analysis

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Comments

Induced sputum and FeNO measured before, at 7 and 24 hours after specific challenge.A 2.2% increase in sputum eosinophils post challenge had a sensitivity 74-79 % (at 7 and 24 hours) and a specificity of 81% aginst specific challenge in 20 challenge positive and 16 challenge negative subjects (post hoc analysis). FeNO showed no significant change at 7 hours, an increase >10ppb at 24 hours had a sensitivity of 37% for a specificity of 81%. The next stage would be to test the 2.2% increase in eosinophils is subjects whose challenges were equivical in terms of FEV1 decline, or who showed a <20% FEV1 fall post challenge. The mean FEV1 fall in this group was high at 30% (SD 11.45). 14/26 had immediate reactions aline.
7/21/2010

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