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Assessment of eosinophilic airway inflammation as a contribution to the diagnosis of occupational asthma

机译：评估嗜酸性嗜酸性气道炎症作为职业哮喘诊断的贡献

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Abstract Background Ascertaining the presence of asthma through the assessment of nonspecific bronchial hyperresponsiveness ( NSBH ) is a key step in the diagnosis of occupational asthma ( OA ). We aimed at investigating whether indices of airway inflammation including fractional exhaled nitric oxide (Fe NO ) and sputum eosinophils would be useful adjuncts to the measurement of NSBH in diagnosing OA defined as a positive specific inhalation challenge ( SIC ). Methods The study included 240 consecutive subjects with a suspicion of OA who completed a SIC , of whom 133 showed a positive response. The sensitivity, specificity, and predictive values of NSBH , and Fe NO , as well as sputum eosinophil counts assessed at baseline of the SIC were determined. Results A concentration of histamine inducing a 20% decline in FEV 1 ( PC 20 ) ≤16 mg/mL showed a sensitivity of 87% and a specificity of 36%. A Fe NO level ≥25 ppb and a sputum eosinophil count ≥2% provided lower sensitivity rates (47% and 39%, respectively) than the PC 20 value. Eight of the 17 subjects without baseline NSBH despite a positive SIC showed a sputum eosinophil count ≥2%, a Fe NO level ≥25 ppb, or both outcomes. Combining either a PC 20 value ≤16 mg/ mL or a Fe NO ≥25 ppb increased the sensitivity to 91%. Using either a PC 20 ≤16 mg/ mL or a sputum eosinophil count ≥1% increased the sensitivity to 94%. Conclusion Adding the assessment of Fe NO level and sputum eosinophils to NSBH improves the identification of subjects who may have OA and require further objective testing before excluding the possibility of OA .
机译：摘要背景通过评估非特异性支气管高反应性（NSBH）来确定哮喘的存在是职业哮喘（OA）诊断的关键步骤。我们旨在研究包括分数呼出的一氧化氮（Fe NO）和痰嗜酸性粒细胞的气道炎症的索引是有用的辅助，用于测量NSBH诊断为阳性特异性吸入攻击（SIC）。方法该研究包括240个连续的主题，涉嫌完成SIC的OA，其中133次表现出积极的反应。确定NSBH和Fe No的敏感性，特异性和预测值，以及在SiC的基线下评估的痰嗜酸性粒细胞计数。结果诱导FEV 1（PC 20）≤16mg/ ml诱导20％下降的组胺浓度显示敏感性为87％，特异性为36％。 Fe no含量≥25ppb和痰嗜酸性粒细胞计数≥2％，但比PC 20值提供较低的灵敏度率（分别为47％和39％）。 17个受试者中的八个没有基线NSBH，尽管阳性SiC表现出痰液嗜纤度粒细胞计数≥2％，Fe No Lever≥25ppb或两种结果。组合PC 20值≤16mg/ ml或Fe≥25ppb增加了91％的敏感性。使用PC20≤16mg/ ml或痰嗜酸性粒细胞计数≥1％增加了敏感度至94％。结论加入FE水平和痰嗜酸性粒细胞对NSBH的评估改善了可能拥有OA的受试者的鉴定，并在不包括OA的可能性之前需要进一步的客观测试。

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