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Open Access Research article

Exhaled nitric oxide and airway hyperresponsiveness in workers: a preliminary study in lifeguards

Valérie Demange1*, Abraham Bohadana23, Nicole Massin1 and Pascal Wild1

Author Affiliations

1 INRS, Département Epidémiologie en Entreprise, Rue du Morvan, CS 60027, 54519 Vandœuvre-lès-Nancy Cedex, France

2 INSERM, U954, Faculté de Médecine, 9, avenue de la forêt de Haye, 54500 Vandoeuvre- lès-Nancy, France

3 Service de Pneumologie; CHU de Nancy; hôpital d'adultes de Brabois, avenue de Bourgogne, 54511 Vandoeuvre-lès-Nancy, France

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BMC Pulmonary Medicine 2009, 9:53  doi:10.1186/1471-2466-9-53

Published: 31 December 2009



Airway inflammation and airway hyperresponsiveness (AHR) are two characteristic features of asthma. Fractional exhaled nitric oxide (FENO) has shown good correlation with AHR in asthmatics. Less information is available about FENO as a marker of inflammation from work exposures. We thus examined the relation between FENO and AHR in lifeguards undergoing exposure to chloramines in indoor pools.


39 lifeguards at six indoor pools were given a respiratory health questionnaire, FENO measurements, spirometry, and a methacholine bronchial challenge (MBC) test. Subjects were labeled MBC+ if the forced expiratory volume (FEV1) fell by 20% or more. The normalized linear dose-response slope (NDRS) was calculated as the percentage fall in FEV1 at the last dose divided by the total dose given. The relation between MBC and FENO was assessed using logistic regression adjusting on confounding factors. The association between NDRS and log-transformed values of FENO was tested in a multiple linear regression model.


The prevalence of lifeguards MBC+ was 37.5%. In reactors, the median FENO was 18.9 ppb (90% of the predicted value) vs. 12.5 ppb (73% predicted) in non-reactors. FENO values ≥ 60% of predicted values were 80% sensitive and 42% specific to identify subjects MBC+. In the logistic regression model no other factor had an effect on MBC after adjusting for FENO. In the linear regression model, NDRS was significantly predicted by log FENO.


In lifeguards working in indoor swimming pools, elevated FENO levels are associated with increased airway responsiveness.