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Occupational and Environmental Lung Disease |

Need for Monitoring Nonspecific Bronchial Hyperresponsiveness Before and After Isocyanate Inhalation Challenge*

Joaquín Sastre; Mar Fernández-Nieto; Ana Novalbos; Manuel de las Heras; Javier Cuesta; Santiago Quirce
Author and Funding Information

*From Fundación Jiménez Díaz, Allergy Department, Madrid, Spain.

Correspondence to: Joaquín Sastre, MD, PhD, FCCP, Fundación Jiménez Díaz, Servicio de Alergia, Av. Reyes Católicos, 2, 28040 Madrid, Spain; e-mail: jsastre@fjd.es



Chest. 2003;123(4):1276-1279. doi:10.1378/chest.123.4.1276
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Background: Specific and nonspecific bronchial responsiveness may decline or disappear after cessation of exposure in the workplace in patients with occupational asthma, leading to false-negative specific inhalation challenge (SIC) results.

Methods: Twenty-two patients with suspected diisocyanate-induced asthma were studied. SIC with diisocyanates (toluene diisocyanate [TDI] or hexamethylene diisocyanate [HDI]) was carried out in a 7-m3 dynamic chamber up to a maximum concentration of 19 parts per billion for 120 min. Methacholine inhalation challenges were performed before and 24 h after SIC with TDI or HDI. Patients who did not show an asthmatic reaction after SIC but had a greater than twofold reduction in provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) after the first isocyanate challenge underwent a second isocyanate SIC 2 days later.

Results: The first SIC with isocyanates elicited an asthmatic reaction in 13 patients (59%). In five patients who did not show an asthmatic reaction after the first SIC, PC20 exhibited more than a twofold reduction. In three of the five patients, a second SIC with isocyanates elicited an immediate positive asthmatic reaction. Therefore, 3 of 16 patients (19%) were ultimately shown to have bronchial responsiveness to isocyanate; occupational asthma was demonstrated due to post-SIC monitoring of bronchial hyperresponsiveness to methacholine.

Conclusion: PC20 should be systematically assessed before and after SIC with isocyanates in the absence of significant changes in FEV1 during SIC to avoid false-negative results.


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