Single breath N2-test and exhaled nitric oxide in men

SummaryThe N2 slope is an index of inhomogeneous distribution of ventilation and has been suggested to be suited for early testing of chronic obstructive pulmonary disease (COPD) in smokers. The aim of the present study was to examine the association between the fraction of exhaled nitric oxide (FENO) and the N2 slope in a random population of smoking and non-smoking men. Altogether 57 subjects were included in the study, 24 never-smokers, seven ex-smokers and 26 current smokers. Subjects were examined twice, in 1995 when they regarded themselves as healthy, and in a follow-up in 2001. Spirometry, N2 slope and high-resolution computed tomography (HRCT) were performed in 1995 while the follow-up examination included also measurement of FENO.The FENO value was significantly lower and the N2 slope higher in current smokers. In smokers but not in never- or ex-smokers FENO was correlated to the difference in N2 slope between 1995 and 2001 (rs=0.49, P=0.01). We analysed the data by multiple linear regression adjusted for smoking, mild respiratory symptoms and inhaled steroids. There were significant associations between FENO and the N2 slope both in 1995 and in 2001. The strongest association was found to exist with the change in N2 slope during these years.Sixteen of the subjects could be classified as having COPD, six with mild and ten with moderate COPD. There was a trend for an increase in N2 slope with increased severity of COPD; among subjects with no COPD the N2 slope in 2001 was 2.3% N2/L, and those with mild and moderate COPD had 2.5% N2/L and 3.9% N2/L, respectively (P=0.0004). No such trend was seen for FENO (17.8, 15.5 and 20.3 parts per billion (ppb), respectively, P=0.8).The results show that FENO is associated with the N2 slope, indicating that FENO reflects inflammatory changes in the peripheral airways of both non-smoking and smoking subjects

Gendered lived experiences of marriage and family following exposure to chemical warfare agents : content analysis of qualitative interviews with survivors in Halabja, Kurdistan-Iraq

Abstract: Objective To study gendered experiences of the longterm effects of a chemical warfare agent (CWA; sulfur mustard). Design Qualitative face-to-face semi-structured in-depth interview study using content analysis approach with thematic analysis and anthropological inquiries. Setting The city of Halabja in the Kurdistan Region of Iraq. Participants Survivors of CWA (n=16, female:male 10:6, mean age 45.5 years (range 34 to 67)) with lung damage diagnosis and with a range of sociodemographic variables. Results Latent content was expressed as: To get or not to get married? Two categories—social abandonment and uncertain marriage—emerged as expressions of the manifest content. The majority of the participants showed uncertainty as a central concern that affects all decision-making in their private and social life. Uncertainty over marriage and family were huge, corresponding to their fear of giving birth to children with congenital birth defects. Exposure to CWAs was conceptualised in terms of stigmatised illnesses, and consequently resulted in loneliness and social isolation, leading to negative impacts on other aspects of professional and social life. The results demonstrated a gendered pattern: CWA-exposed women were more affected psychosocially than CWA-exposed men. More CWA-exposed women were unemployed, divorced or single, or lived under vulnerable circumstances compared with men. Conclusion Survivors of CWA exposure have developed a sense of gendered uncertainty around getting married and building a family. Sulfur mustard-exposed women, in particular, long to be desired in the community as they face social exclusion. Survivors should be provided evidence-based consultancy to optimise their decisionmaking around marriage and other social and family challenges

Exhaled nitric oxide and urinary EPX levels in infants: a pilot study

<p>Abstract</p> <p>Background</p> <p>Objective markers of early airway inflammation in infants are not established but are of great interest in a scientific setting. Exhaled nitric oxide (FeNO) and urinary eosinophilic protein X (uEPX) are a two such interesting markers.</p> <p>Objective</p> <p>To investigate the feasibility of measuring FeNO and uEPX in infants and their mothers and to determine if any relations between these two variables and environmental factors can be seen in a small sample size. This was conducted as a pilot study for the ongoing Swedish Environmental Longitudinal Mother and child Asthma and allergy study (SELMA).</p> <p>Methods</p> <p>Consecutive infants between two and six months old and their mothers at children's health care centres were invited, and 110 mother-infant pairs participated. FeNO and uEPX were analysed in both mothers and infants. FeNO was analyzed in the mothers online by the use of the handheld Niox Mino device and in the infants offline from exhaled air sampled during tidal breathing. A 33-question multiple-choice questionnaire that dealt with symptoms of allergic disease, heredity, and housing characteristics was used.</p> <p>Results</p> <p>FeNO levels were reduced in infants with a history of upper respiratory symptoms during the previous two weeks (p < 0.002). There was a trend towards higher FeNO levels in infants with windowpane condensation in the home (p < 0.05). There was no association between uEPX in the infants and the other studied variables.</p> <p>Conclusion</p> <p>The use of uEPX as a marker of early inflammation was not supported. FeNO levels in infants were associated to windowpane condensation. Measuring FeNO by the present method may be an interesting way of evaluating early airway inflammation. In a major population study, however, the method is difficult to use, for practical reasons.</p

Bronchial Responsiveness Is Related to Increased Exhaled NO (FENO) in Non-Smokers and Decreased FENO in Smokers

Rationale Both atopy and smoking are known to be associated with increased bronchial responsiveness. Fraction of nitric oxide (NO) in the exhaled air (FENO), a marker of airways inflammation, is decreased by smoking and increased by atopy. NO has also a physiological bronchodilating and bronchoprotective role. Objectives To investigate how the relation between FENO and bronchial responsiveness is modulated by atopy and smoking habits. Methods Exhaled NO measurements and methacholine challenge were performed in 468 subjects from the random sample of three European Community Respiratory Health Survey II centers: Turin (Italy), Gothenburg and Uppsala (both Sweden). Atopy status was defined by using specific IgE measurements while smoking status was questionnaire-assessed. Main Results Increased bronchial responsiveness was associated with increased FENO levels in non-smokers (p = 0.02) and decreased FENO levels in current smokers (p = 0.03). The negative association between bronchial responsiveness and FENO was seen only in the group smoking less &lt;10 cigarettes/day (p = 0.008). Increased bronchial responsiveness was associated with increased FENO in atopic subjects (p = 0.04) while no significant association was found in non-atopic participants. The reported interaction between FENO and smoking and atopy, respectively were maintained after adjusting for possible confounders (p-values&lt;0.05). Conclusions The present study highlights the interactions of the relationship between FENO and bronchial responsiveness with smoking and atopy, suggesting different mechanisms behind atopy- and smoking-related increases of bronchial responsiveness

ADONIX-studien

"ADONIX" is an acronyme for "Adult-onset asthma and nitric oxide" and is the collective name for the population study conducted by the Department of Occupational and Environmental Medicine, University of Gothenburg. 6685 randomly selected persons aged 25-75 years, have participated. The ADONIX study collaborates with the INTERGENE study and the PURE study, both at the University of Gothenburg. The study examines the prevalence of airway inflammation using exhaled nitric oxide (NO) by putting this in relation to the concentration of small particulates in the air on the particular day the measurement was made and the days before. Air pollution data are imported from Gothenburg Environmental Administration and other municipalities in Västra Götaland. Measurement of nitric oxide in exhaled air may eventually become a good test to diagnose asthma or other lung disease. The subjects also do a lung function test (spirometry), and answer questions concerning background factors such as recent job, allergies, asthma and heredity, and the current exposure of different kinds of air pollution both indoors and outdoors. In addition, anthropometric measurements, measurement of body composition, ECG, blood tests and questionnaires on lifestyle factors (in collaboration with INTERGENE and PURE). Follow up with a new survey is planned to start 2013. Purpose: The original primary aim was investigating whether increased fraction of exhaled nitric oxide (FENO) is associated with an increased risk for new-onset asthma. This has been extended to an overall aim to increase the understanding of the interactions between different risk factors and genetic susceptibility in the mechanisms and prognosis for asthma and chronic obstructive pulmonary disease (COPD), coronary heart diseases and stroke. 2490 of the participants are also part of the INTERGENE study"ADONIX" står för "Adult-onset asthma and nitric oxide" och är samlingsnamnet för den populationsstudie som Enheten för Arbets- och miljömedicin vid Göteborgs Universitet bedriver. 6685 slumpmässigt utvalda personer i åldern 25-75 år i Västra Götaland har deltagit. ADONIX-studien samarbetar med INTERGENE-studien och PURE-studien, båda också vid Göteborgs Universitet. I studien undersöks förekomsten av luftvägsinflammation med hjälp av utandad kväveoxid (NO) genom att sätta detta i relation till halten av små partiklar i omgivningsluft just den dagen mätningen görs och dagarna innan. Luftföroreningsdata hämtas från Göteborgs Miljöförvaltning och andra kommuner i Västra Götaland. Mätning av kväveoxid i utandningsluft kan på sikt bli ett bra test att diagnosticera astma eller annan lungsjukdom. Försökspersonerna gör även ett lungfunktionstest (spirometri) och besvarar frågor rörande bakgrundsfaktorer såsom tidigare arbetsuppgifter, allergiska besvär, astma och ärftlighet, samt om aktuell exponering av olika sorters luftföroreningar såväl inom- som utomhus. Dessutom ingår antropometriska mått, mätning av kroppssammansättning, EKG, blodprov samt enkäter med frågor om bl a livsstilsfaktorer (i samarbete med INTERGENE och PURE). Uppföljning med ny undersökning är planerad att påbörjas 2013. Syfte: Det ursprungliga primära syftet var att undersöka om ökad kväveoxidhalt i utandningsluft (FENO) är associerat med en ökad risk för nydebuterad astma. Detta har utvidgats till ett övergripande mål att öka förståelsen för samspelet mellan olika riskfaktorer och genetisk sårbarhet i mekanismer och prognos för astma och kronisk obstruktiv lungsjukdom (KOL), hjärt-kärlsjukdomar och stroke. 2490 av deltagarna ingår även i INTERGENE-studie

Exhaled Nitric Oxide in epidemiological and experimental studies

The overall purpose with this thesis has been to contribute to the assessment of theutility of exhaled nitric oxide (eNO) in epidemiological studies. The specific aims have been toinvestigate whether eNO increases after occupational exposure to high peaks of ozone, or afterexperimental exposure to ozone in ambient concentrations. The aim has also been to seewhether occupational exposure to ozone increases the risk of asthma or rhinitis. A furtherintention has been to examine the association between atopy and exhaled NO. The influence ofintake of nitrate-rich food on exhaled NO was also studied.Two cross-sectional studies of bleachery workers were carried out, where in the first 56bleachery workers and 39 controls were examined and in the second, performed three yearslater, 228 bleachery workers and 63 controls. All were examined with measurements of exhalednitric oxide (eNO), lungfunction, questionnaires and blood samples. How atopy andsensitization were related to eNO and respiratory symptoms among the non-smoking subjectswas also studied. Furthermore eNO was measured after experimental exposure to ozone where11 healthy volunteers were randomly exposed to 200 ppb ozone or filtered air for two hours.eNO was measured before and directly afterwards, as well as six and 24 hours later. The effectof intake of a meal rich in nitrate on the concentration of nitrate in plasma and eNO, wasexamined in 16 healthy volunteers, who had been on a low nitrate diet for three days.There was no difference in eNO between bleachery workers and controls in either of the twostudies. Within the exposed group, those who had reported ozone exposure followed byrespiratory symptoms ( gassings ) had elevated levels of eNO (58.8 vs. 90.0 nL/min, p=0.019).The same was found in the second study, although only four or more gassings were associatedwith increased eNO (0 gassing: 15.7 ppb, 1-3 gassings: 14.1 ppb and &gt;3 gassings 19.2 ppb,p=0.037). In the second study there were significantly increasing prevalences of rhinitis, adultonsetasthma and current asthma symptoms with increasing frequency of gassings. The atopicsubjects without asthma and rhinitis had eNO levels within the range of non-atopic subjects.Among the atopic subjects reporting symptoms of asthma or rhinitis, only those sensitized toperennial allergen had elevated NO levels. No significant changes of eNO were found afterexperimental exposure to ozone, when adjusting for changes of eNO after filtered air. eNO andplasma nitrate levels were increasing significantly up to two hours after the nitrate-rich meal,with a median increase of 47% (range 7-89%). The increase of eNO and plasma nitrate wascorrelated (rs=0.57, p=0.03).To conclude: gassings from ozone seem to be associated with increased prevalence of adultonset asthma, current asthma symptoms and rhinitis. eNO appears to be a marker for airwayinflammation after repeated occupational exposure to ozone, but not after experimentalexposure to ozone in ambient concentrations. Sensitization to perennial allergens and reportedsymptoms of asthma or rhinitis were found to be associated with higher levels of eNO. Intakeof nitrate- rich food may increase the levels of eNO, and should be restricted or noted beforemeasuring eNO