Specific provocation tests are used to confirm diagnosis of occupational asthma or rhinitis. Decreases of FEV1 or nasal flow are considered to be main markers of positivity. Analysis of breath condensate brings more information for monitoring processes in airways during these tests.
Six patients (average age 38.7 years) with suspicion on occupational asthma (OA) and rhinitis (OR) and four controls (average age 53.8 years) were examined. Total immunoglobuline E (IgE), blood eosinophils, spirometry, rhinomanometry, non-specific bronchoprovocation test, specific bronchoprovocation tests with occupational allergens were performed. Leukotrienes C4, D4, E4 from breath condensate were analyzed by HPLC/MS, leukotriene B4 on solid phase extraction. Student t-test and correlation coefficient were used for statistical analysis.
Occupational asthma was finally diagnosed in three patients, occupational rhinitis in three patients. In patients with OA, OR and controls IgE levels were 828.3 vs. 564.0 vs. 34.8 mg/l; FEV1 80.3 vs. 95.6 vs. 109.0 % predicted values; leukotrienes on admission B4 43.3 vs. 2.6 vs. 46.3 pg/mL; C4 114.0 vs. 54.7 vs. 85.0 pg/mL; D4 17.0 vs. 10.7 vs. 35.5 pg/mL; E4 20.0 vs. 13.7 vs. 28.3 pg/mL. Significant changes in FEV1 (p<0.05) were found between asthmatics and controls.Breath condensate leukotrienes were analysed also before specific test and at the time of maximal decrease of FEV1 or nasal flow during the test: OA patients - B4 (53.7 vs. 56.7 pg/mL), C4 (121.7 vs. 198.0 pg/mL), D4 (17.0 vs. 17.0 pg/mL), E4 (21.3 vs. 21.0 pg/mL), OR patients - B4 (13.0 vs. 17.3 pg/mL), C4 (266.3 vs. 257.3 pg/mL), D4 (19.3 vs. 17.0 pg/mL), E4 (17.3 vs. 15.6 pg/mL). No significant correlations were found.
Maximum decrease of FEV1 during specific tests with occupational allergens in our small group of patients does not to seem to correspond with elevation of markers of obstruction in breath condensate.
Changes in obstruction markers in breath condensate probably precede or follow decrease of FEV1. These possibilities will be tested in further provocation tests measurements. Acknowledgement: IGAMZCR NR8109-3/2004.
Daniela Pelclova, None.