Abstract
BackgroundAirway inflammation and airway hyperresponsiveness (AHR) are two characteristic features of asthma. Fractional exhaled nitric oxide (FENO) has shown good correlation with AHR in asthmatics. Less information is available about FENO as a marker of inflammation from work exposures. We thus examined the relation between FENO and AHR in lifeguards undergoing exposure to chloramines in indoor pools.Methods39 lifeguards at six indoor pools were given a respiratory health questionnaire, FENO measurements, spirometry, and a methacholine bronchial challenge (MBC) test. Subjects were labeled MBC+ if the forced expiratory volume (FEV1) fell by 20% or more. The normalized linear dose-response slope (NDRS) was calculated as the percentage fall in FEV1 at the last dose divided by the total dose given. The relation between MBC and FENO was assessed using logistic regression adjusting on confounding factors. The association between NDRS and log-transformed values of FENO was tested in a multiple linear regression model.ResultsThe prevalence of lifeguards MBC+ was 37.5%. In reactors, the median FENO was 18.9 ppb (90% of the predicted value) vs. 12.5 ppb (73% predicted) in non-reactors. FENO values ≥ 60% of predicted values were 80% sensitive and 42% specific to identify subjects MBC+. In the logistic regression model no other factor had an effect on MBC after adjusting for FENO. In the linear regression model, NDRS was significantly predicted by log FENO.ConclusionsIn lifeguards working in indoor swimming pools, elevated FENO levels are associated with increased airway responsiveness.
Highlights
Airway inflammation and airway hyperresponsiveness (AHR) are two characteristic features of asthma
In the linear regression model, normalized linear dose-response slope (NDRS) was significantly predicted by log Fractional exhaled nitric oxide (FENO)
In lifeguards working in indoor swimming pools, elevated FENO levels are associated with increased airway responsiveness
Summary
Airway inflammation and airway hyperresponsiveness (AHR) are two characteristic features of asthma. Less information is available about FENO as a marker of inflammation from work exposures. We examined the relation between FENO and AHR in lifeguards undergoing exposure to chloramines in indoor pools. Airway inflammation is the hallmark of asthma[1]. Exposure to a variety of agents in the workplace can cause airway inflammation and occupational asthma. Investigating airway inflammation from work exposure is important to elaborate preventive strategies. Airway hyperresponsiveness (AHR) can be considered as a surrogate marker of airway inflammation and is recognized as another characteristic finding of asthma[1]. AHR is an important determinant for the development of symptoms[3]
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