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The use of fractional exhaled nitric oxide in investigation of work-related cough in a hairdresser

Authors

  • Gianni Pala MD,

    Corresponding author
    1. Allergy and Immunology Unit, Fondazione ‘Salvatore Maugeri’, Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
    • Allergy and Immunology Unit, Fondazione ‘Salvatore Maugeri’, Institute of Care and Research, Scientific Institute of Pavia, Via Maugeri 10, Pavia, Italy.
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  • Patrizia Pignatti PhD,

    1. Allergy and Immunology Unit, Fondazione ‘Salvatore Maugeri’, Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
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  • Gianna Moscato MD

    1. Allergy and Immunology Unit, Fondazione ‘Salvatore Maugeri’, Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
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Abstract

Background

Occupational and environmental factors may be a cause of nonasthmatic eosinophilic bronchitis (NAEB). The diagnosis of occupational NAEB requires evidence of sputum eosinophilia. Nevertheless, a minority of patients are not able to produce suitable sputum specimens.

Methods

This case report describes a 25-year-old woman, working as a hairdresser since the age of 20 years and handling ammonium persulfate, who came under our observation for work-related rhinitis and cough.

Results

A specific inhalation challenge with ammonium persulfate elicited dry cough, without any significant change in forced expiratory volume in 1 s (FEV1). Sputum induction was unsuccessful both pre- and after specific inhalation challenge. Fractional exhaled nitric oxide (FeNO) values significantly increased after specific inhalation challenge, suggesting a diagnosis of occupational NAEB due to ammonium persulfate.

Conclusions

From this observation we suggest that FeNO measurement should be added to the investigation of work-related cough during specific inhalation challenge, and may be considered as an alternative to induced sputum to evaluate bronchial inflammation when sputum collection is unavailable or unsuccessful. Am. J. Ind. Med. 54:565–568, 2011. © 2011 Wiley-Liss, Inc.

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