Exhaled nitric oxide and airway hyperresponsiveness in workers: a preliminary study in lifeguards

• Published in: BMC pulmonary medicine Vol. 9; no. 1; p. 53
• Main Authors: Demange, Valérie, Bohadana, Abraham, Massin, Nicole, Wild, Pascal
• Format: Journal Article
• Language: English
• Published: England BioMed Central 31.12.2009; BioMed Central Ltd; BMC
• Subjects: Adult; Asthma; Asthma - diagnosis; Asthma - metabolism; Asthma - physiopathology; Bronchial Provocation Tests; Cigarettes; Cross-Sectional Studies; Data collection; Feasibility Studies; Female; Forced Expiratory Volume; Forced Expiratory Volume - physiology; Human health and pathology; Humans; Life Sciences; Linear Models; Male; Methacholine Chloride; Nitric Oxide; Nitric Oxide - metabolism; Occupational Health; Predictive Value of Tests; Pulmonology; Pulmonology and respiratory tract; Research article; Respiratory Hypersensitivity; Respiratory Hypersensitivity - diagnosis; Respiratory Hypersensitivity - metabolism; Respiratory Hypersensitivity - physiopathology; Sensitivity and Specificity; Spirometry; Swimming; Swimming - physiology; Underground construction
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/1471-2466-9-53

Airway 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. 39 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. The 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 >or= 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. In lifeguards working in indoor swimming pools, elevated FENO levels are associated with increased airway responsiveness.