Occupational Asthma Reference

Sánchez-Vidaurre S, Cruz M, Gómez-Ollés S, Morell F, Muñoz X, Diagnostic utility of exhaledbreath condensate analysis in conjunction with specific inhalation challenge in individuals with suspected work-related asthma, Ann Allergy Asthma Immunol, 2012;108:151-156,
(Plain text: Sanchez-Vidaurre S, Cruz M, Gomez-Olles S, Morell F, Munoz X, Diagnostic utility of exhaledbreath condensate analysis in conjunction with specific inhalation challenge in individuals with suspected work-related asthma, Ann Allergy Asthma Immunol)

Keywords: exhaled breath condensate, PH, Spain, SIC, nitrite

Known Authors

Maria Jesus Cruz, Barcelona Maria Jesus Cruz

Xavier Munoz, Barcelona Xavier Munoz

Ferran Morell, Vall d'Hebron Hospital, Barcelona Ferran Morell

Susana Gomez-Olles, Barcelona Susana Gomez-Olles

Susana Gomez-Olles, Barcelona Susana Gomez-Olles

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Abstract

Background
Establishing the role of exhaledbreath condensate (EBC) analysis in work-related asthma (WRA), and more specifically, in conjunction with specific inhalation challenge (SIC), is difficult.

Objective
To measure EBC pH, and nitrite/nitrate concentrations before and after SIC in individuals with suspected WRA exposed to either high-molecular-weight (HMW) or low-molecular-weight (LMW) agents and evaluate whether these changes are useful to distinguish between occupational asthma (OA) and work-exacerbated asthma (WEA).

Methods
One hundred twenty-five consecutive workers undergoing SIC were enrolled. Exhaledbreath condensate was collected at the end of the baseline day and 24 hours after exposure to the offending agent. In all EBC samples, pH was measured, and nitrite and nitrate concentrations were determined.

Results
Specific inhalation challenge was positive in 66 individuals, who were then diagnosed with OA. Work-exacerbated asthma was diagnosed in 14, and in 45 patients establishing a direct relationship between the symptoms and work exposure was not possible. In patients with WEA, EBC pH values after SIC were significantly lower than those before SIC (P = .0047). Using the receiver operating characteristic (ROC) curve, we found that an EBC pH decrease of greater than 0.4 units after SIC achieved the most satisfactory sensitivity 79% (confidence interval [CI]: 49–94) and specificity of 100% (CI: 68–100), considering only patients with asthma and without OA. A decrease in EBC pH of 0.4 or more common in those exposed to HMW agents (8/19, 42%) than in those exposed to LMW agents (7/47, 15%).

Conclusions
Exhaled breath condensate pH in conjunction with SIC may be useful for diagnosing WEA.

Plain text: Background Establishing the role of exhaledbreath condensate (EBC) analysis in work-related asthma (WRA), and more specifically, in conjunction with specific inhalation challenge (SIC), is difficult. Objective To measure EBC pH, and nitrite/nitrate concentrations before and after SIC in individuals with suspected WRA exposed to either high-molecular-weight (HMW) or low-molecular-weight (LMW) agents and evaluate whether these changes are useful to distinguish between occupational asthma (OA) and work-exacerbated asthma (WEA). Methods One hundred twenty-five consecutive workers undergoing SIC were enrolled. Exhaledbreath condensate was collected at the end of the baseline day and 24 hours after exposure to the offending agent. In all EBC samples, pH was measured, and nitrite and nitrate concentrations were determined. Results Specific inhalation challenge was positive in 66 individuals, who were then diagnosed with OA. Work-exacerbated asthma was diagnosed in 14, and in 45 patients establishing a direct relationship between the symptoms and work exposure was not possible. In patients with WEA, EBC pH values after SIC were significantly lower than those before SIC (P = .0047). Using the receiver operating characteristic (ROC) curve, we found that an EBC pH decrease of greater than 0.4 units after SIC achieved the most satisfactory sensitivity 79% (confidence interval [CI]: 49-94) and specificity of 100% (CI: 68-100), considering only patients with asthma and without OA. A decrease in EBC pH of 0.4 or more common in those exposed to HMW agents (8/19, 42%) than in those exposed to LMW agents (7/47, 15%). Conclusions Exhaled breath condensate pH in conjunction with SIC may be useful for diagnosing WEA.

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