Occupational Asthma Reference

Bohadana AB, Hannhart B, Ghezzo H, Teculescu D, Zmirou-Navier D, Exhaled nitric oxide and spirometry in respiratory health surveillance, Occup Med, 2011;61:108-114,

Keywords: France, baker, apprentice, hairdresser, FeNO, nitric oxide,

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Heberto Ghezzo, Montreal Heberto Ghezzo

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Exposure to pollutants in bakeries and hairdressing salons can cause airway syndromes varying from bronchial irritation to asthma. Workplace respiratory health surveillance aims to identify possible cases requiring further investigation.

To compare the performance of fractional exhaled nitric oxide (FENO) and spirometry for health surveillance of apprentice bakers (ABs) and apprentice hairdressers (AHDs). Determinants of FENO were also identified.

Symptoms and physician-diagnosed asthma were evaluated by questionnaire. FENO was measured and spirometry was carried out. Subjects with elevated FENO (FENO > upper limit normal), airway obstruction [forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 95th percentile] and atopy (history of allergies) were identified.

A total of 126 apprentices (59 ABs and 67 AHDs) participated. Twenty-nine (23%) apprentices had abnormal tests: 4 had associated high FENO and airway obstruction, while 25 had either high FENO (n = 15) or airway obstruction (n = 10) alone. Compared with ABs (n = 16), AHDs (n = 13) had more asthma (38 versus 0%; P < 0.05) and atopy (62 versus 6%; P < 0.05). There was no difference in symptoms, smoking FENO or airways obstruction. Among 97 subjects with normal tests, no differences existed between ABs (n = 53) and AHDs (n = 44). Average FENO was increased in atopic non-smokers compared with atopic smokers and non-atopic subjects (P < 0.05). Smoking, a history of allergies, FEV1/FVC % observed and respiratory symptoms were the main determinants of FENO.

FENO and spirometry were not overlapping dimensions in ABs and hairdressers, each test contributing unique information on the physiological status of the respiratory system. FENO may provide added information on airway inflammation not provided by spirometry

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