The value of fractional exhaled nitric oxide in occupational diseases - a systematic review

Marina Ruxandra Oțelea; Anne Kristin M Fell; Claudia Mariana Handra; Mathias Holm; Francesca Larese Filon; Dragan Mijakovski; Jordan Minov; Andreea Mutu; Euripides Stephanou; Zara Ann Stokholm; Sasho Stoleski; Vivi Schlünssen

doi:10.1186/s12995-022-00355-1

The value of fractional exhaled nitric oxide in occupational diseases - a systematic review

J Occup Med Toxicol. 2022 Jul 25;17(1):14. doi: 10.1186/s12995-022-00355-1.

Authors

Marina Ruxandra Oțelea¹, Anne Kristin M Fell^{2

3}, Claudia Mariana Handra^{4

5}, Mathias Holm⁶, Francesca Larese Filon⁷, Dragan Mijakovski^{8

9}, Jordan Minov^{8

9}, Andreea Mutu^{4

10}, Euripides Stephanou¹¹, Zara Ann Stokholm¹², Sasho Stoleski^{8

9}, Vivi Schlünssen¹³

Affiliations

¹ Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. marina.otelea@umfcd.ro.
² Occupational and Environmental Medicine, Telemark Hospital, Skien, Norway.
³ Department of Global Health and Community Medicine, Institute of Health and Community, University of Oslo, Oslo, Norway.
⁴ Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
⁵ Colentina Clinical Hospital, Clinic for Occupational Medicine, Bucharest, Romania.
⁶ Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy.
⁸ Institute of Occupational Health of RN Macedonia, Skopje, North Macedonia.
⁹ Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, Skopje, North Macedonia.
¹⁰ Central Military University Emergency Hospital "Carol Davila", Bucharest, Romania.
¹¹ University of Crete, Heraklion, Greece.
¹² Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.
¹³ Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark.

Abstract

Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of respiratory tract inflammation, originally designated to identify eosinophilic airway inflammation and to predict steroid response. The main field of application of this biomarker is asthma, but FeNO has also been used for other allergic and non-allergic pulmonary disorders such as chronic obstructive pulmonary disease, hypersensitivity pneumonitis and interstitial lung disease. A substantial part of respiratory diseases are related to work, and FeNO, a safe and easy measure to conduct, is a potential valid examination in an occupational setting.This systematic review assesses the value of measuring FeNO related to three types of airborne exposures: allergens, irritants, and respiratory particles inhaled during occupational activities. The review covers results from longitudinal and observational clinical studies, and highlights the added value of this biomarker in monitoring effects of exposure and in the diagnostic criteria of occupational diseases. This review also covers the possible significance of FeNO as an indicator of the efficacy of interventions to prevent work-related respiratory diseases.Initially, 246 articles were identified in PUBMED and SCOPUS. Duplicates and articles which covered results from the general population, symptoms (not disease) related to work, non-occupational diseases, and case reports were excluded. Finally, 39 articles contributed to this review, which led to the following conclusions:a) For occupational asthma there is no consensus on the significant value of FeNO for diagnosis, or on the magnitude of change needed after specific inhalation test or occupational exposure at the workplace. There is some consensus for the optimal time to measure FeNO after exposure, mainly after 24 h, and FeNO proved to be more sensitive than spirometry in measuring the result of an intervention. b) For other occupational obstructive respiratory diseases, current data suggests performing the measurement after the work shift. c) For interstitial lung disease, the evaluation of the alveolar component of NO is probably the most suitable.

Keywords: Fractional exhaled nitric oxide (FeNO); Occupational asthma; Occupational bronchitis; Occupational hypersensitivity pneumonitis; Occupational interstitial lung disease.