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Utility of Exhaled Nitric Oxide Fraction for the Diagnosis of Hypersensitivity Pneumonitis

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Abstract

Background

There is very little evidence of the utility of the exhaled fraction of NO (FeNO) for the diagnosis of interstitial lung disease and nearly all of it is related with connective tissue disease. Some authors have suggested that in patients with hypersensitivity pneumonitis (HP), evolution to pulmonary fibrosis may be mediated by a Th2 mechanism, which could redound in a potential utility of FeNO. The aim of this study was to investigate the values of FeNO before and after antigenic exposure with the specific inhalation challenge (SIC) and to analyze its potential utility for the diagnosis of HP.

Methods

It was a prospective, cross-sectional study of all patients older than 18 years referred to our center for suspected chronic HP between May 2012 and May 2014 and who underwent a SIC. FeNO was collected before and after SIC.

Results

The study sample comprised 25 patients. Eleven were diagnosed with chronic HP; six had been exposed to avian proteins and five to fungal agents. Of these 11 patients, seven had positive SICs. In the 14 patients with diagnoses other than HP, all the SICs were negative. No significant differences in baseline characteristics were observed according to HP diagnosis, except in the BAL lymphocyte count. No differences were found after the test in patients diagnosed with HP; nor were there differences in baseline FeNO in patients diagnosed with HP and those who received alternative diagnoses.

Conclusions

The results suggest that FeNO measurement is not useful for the diagnosis of chronic HP.

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Acknowledgments

This study was supported by FIS PI13/01076 (Instituto de Salud Carlos III) and Sociedad Española de Patología Respiratoria (SEPAR, Spanish Society of Respiratory Disease). MJC is a researcher supported by the Miguel Servet programme from Instituto de Salud Carlos III (CP12/03101). The funders had no role in the study design, data collection or analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Respiratory Service, Department of Medicine, Vall d’Hebron University Hospital, Autonomous University of Barcelona, Passeig Vall d’Hebron, 119, 08035, Barcelona, Catalonia, Spain

    I. Ojanguren, M. J. Cruz, A. Villar, M. Barrecheguren, F. Morell & X. Muñoz

  2. CIBER Enfermedades Respiratorias (Ciberes), Barcelona, Spain

    I. Ojanguren, M. J. Cruz, F. Morell & X. Muñoz

  3. Department of Cell Biology, Physiology and Immunology, Autonomous University of Barcelona, Barcelona, Catalonia, Spain

    X. Muñoz

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  1. I. Ojanguren
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  2. M. J. Cruz
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  3. A. Villar
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  4. M. Barrecheguren
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  5. F. Morell
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  6. X. Muñoz
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Correspondence to M. J. Cruz.

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Ojanguren, I., Cruz, M.J., Villar, A. et al. Utility of Exhaled Nitric Oxide Fraction for the Diagnosis of Hypersensitivity Pneumonitis. Lung 194, 75–80 (2016). https://doi.org/10.1007/s00408-015-9824-5

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  • DOI: https://doi.org/10.1007/s00408-015-9824-5

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