학령 전기 환아에서 아토피성 천식과 비아토피성 천식의 메타콜린과 아데노신 기관지 유발검사의 비교
Comparison of Methacholine and Adenosine 5'-Monophosphate Responsiveness Between Preschool Children with Atopic Asthma and Those with Nonatopic Asthma
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목 적 : 간접적 기관지 수축제인 아데노신 기관지 과민성은 직접적 기관지 수축제인 메타콜린 기관지 과민성에 비해 아토피 상태를 좀 더 잘 반영하는 것으로 알려져 있으나, 이러한 비교가 학령 전기 소아에서는 아직 국내에 보고된 바 없다. 본 연구는 학령전기 소아를 대상으로 아토피성 천식과 비아토피성 천식에서 메타콜린에 대한 반응과 아데노신에 대한 반응의 차이가 있는지 알아보고자 하였다. 방 법 : 천식으로 진단받은 4-6세의 소아 177명을 대상으로 하였고 이 중에 아토피성 천식군이 145명, 비아토피성 천식군이 32명이었다. 메타콜린과 아데노신 흡입 검사를 시행하였고 기관지 유발검사에 대한 반응은 청진상 천명과 산소포화도의 저하를 기준으로 메타콜린 종점 농도(endpoint concentration)와 아데노신 종점 농도로 나타내었다. 기관지 과민성의 판정 기준은 각각 메타콜린 종점 농도가 8 mg/mL미만인 경우와 아데노신 종점농도가 200 mg/mL미만인 경우로 하였다. 결 과 : 아토피성 천식군에서 각각 96.5% (140명)와 86.8% (126명)가 메타콜린 기관지 유발검사와 아데노신 기관지 유발검사에 양성을 보였고, 비아토피성 천식군에서는 각각 84.3% (27명)와 75% (24명)가 메타콜린 기관지 유발검사와 아데노신 기관지 유발검사에 양성을 나타내었다. 메타콜린 종점 농도의 기하평균은 군간에 유의한 차이가 없었으나, 아데노신 종점 농도의 기하평균은 아토피성 천식군에서 25.5 mg/mL, 비아토피성 천식군에서 59.4 mg/mL으로 아토피성 천식군에서 유의하게 낮은 값을 보였다.(P=0.010) 결 론 : 학령 전기의 아토피성 천식 환아와 비아토피성 천식 환아에서 메타콜린 기관지 과민성은 유의한 차이가 나타나지 않았으나, 아데노신 기관지 과민성은 아토피성 천식 환아에서 의미있게 증가되었다. 학령 전기 천식 환아에서 아토피성 천식과 비아토피성 천식간에 발병기전의 차이를 아데노신 기관지 유발검사가 보다 민감하게 반영함을 시사한다.
Abstract
Purpose : It is well known that atopy is a major determinant of bronchial hyperresponsiveness (BHR) in both asymptomatic and asthmatic children. However, the relationship between atopy and BHR has not been well studied in preschool children with asthma. The aim of this study was to evaluate and compare BHR to direct and indirect stimuli between young children with atopic asthma and those with nonatopic asthma. Methods : Methacholine and adenosine 5'-monophosphate (AMP) bronchial challenges were performed on 177 preschool children with asthma (145 atopics and 32 nonatopics) using a modified auscultation method. The endpoint was defined as the appearance of wheezing and/or oxygen desaturation. Results : While the geometric mean of methacholine endpoint concentration was not significantly different between atopics and nonatopics that of the AMP endpoint concentration was significantly lower in atopics than in nonatopics (25.5 vs. 59.4 mg/mL; P=0.032). A positive response to methacholine (an end-point concentration ≤8 mg/mL) was observed in 96.5% (140/145) of patients with atopic asthma and in 84.3% (27/32) with non-atopic asthma. The frequency of a positive response to AMP (an endpoint concentration ≤200 mg/mL) was 86.8% (126/145) in patients with atopic asthma and 75% (24/32) in these with non-atopic asthma. Conclusion : Atopics more frequently displayed BHR to AMP and had a higher responsiveness to AMP than nonatopics. These results suggest that atopic and non-atopic asthma in preschool children may be related to the distinctive pathophysiologic pathways.
참고문헌 (33)
- Lemanske RF, Jr., "6. Asthma", J Allergy Clin Immunol, 111, pp.502S~519S (2003)
- Polosa R, "Adenosine bronchoprovocation: a promising marker of allergic inflammation in asthma?", Thorax, 52, pp.919~923 (1997)
- Joos GF, "Indirect bronchial provocation tests: a new, specific group of bronchial provocation tests for asthma", Verh K Acad Geneeskd Belg, 67, pp.153~167 (2005)
- Avital A, "Comparison of adenosine 5'-monophosphate and methacholine for the differentiation of asthma from chronic airway diseases with the use of the auscultative method in very young children", J Pediatr, 127, pp.438~440 (1995)
- Avital A, "Adenosine, methacholine, and exercise challenges in children with asthma or paediatric chronic obstructive pulmonary disease", Thorax, 50, pp.511~516 (1995)
- Rogers DF, "Airway hyperresponsiveness: relation to asthma and inflammation?", Thorax, 48, pp.1095~1096 (1993)
- Corrigan C, "Mechanisms of intrinsic asthma", Curr Opin Allergy Clin Immunol, 4, pp.53~56 (2004)
- Ludviksdottir D, "Different airway responsiveness profiles in atopic asthma, nonatopic asthma, and Sjogren's syndrome. BHR Study Group. Bronchial hyperresponsiveness", Allergy, 55, pp.259~265 (2000)
- Phillips GD, "Absence of a late- phase response or increase in histamine responsiveness after bronchial provocation with adenosine 5'-monophosphate in atopic and non-atopic asthma", Clin Sci (Lond), 75, pp.429~436 (1988)
- Duiverman EJ, "Bronchial responsiveness in asthmatic children aged 3 to 8 years measured by forced pseudo-random noise oscillometry", Bull Eur Physiopathol Respir, 22, pp.27~33 (1986)
- Buhr W, "Correspondence between forced oscillation and body plethysmography during bronchoprovocation with carbachol in children", Pediatr Pulmonol, 8, pp.280~288 (1990)
- Noviski N, "Bronchial provocation determined by breath sounds compared with lung function", Arch Dis Child, 66, pp.952~955 (1991)
- Wilson NM, "Use of transcutaneous oxygen tension, arterial oxygen saturation, and respiratory resistance to assess the response to inhaled methacholine in asthmatic children and normal adults", Thorax, 46, pp.433~437 (1991)
- Wilson NM, "The measurement of methacholine responsiveness in 5 year old children: three methods compared", Eur Respir J, 8, pp.364~370 (1995)
- Mochizuki H, "A new method of estimating bronchial hyper-responsiveness in younger children", Ann Allergy, 55, pp.162~166 (1985)
- Cockcroft DW, "Bronchial reactivity to inhaled histamine: a method and clinical survey", Clin Allergy, 7, pp.235~243 (1977)
- Springer C, "Efficacy and safety of methacholine bronchial challenge performed by auscultation in young asthmatic children", Am J Respir Crit Care Med, 162, pp.857~860 (2000)
- Avital A, "Exhaled nitric oxide and asthma in young children", Pediatr Pulmonol, 32, pp.308~313 (2001)
- "British Guideline on the Management of Asthma", Thorax, 63, pp.iv1~iv121 (2008)
- Jansen DF, "(A)symptomatic bronchial hyper- responsiveness and asthma", Respir Med, 91, pp.121~134 (1997)
- Avital A, "Bronchial provocation tests in young children using tracheal auscultation", J Pediatr, 112, pp.591~594 (1988)
- Gavriely N, "Analysis of breath sounds in bronchial provocation tests", Am J Respir Crit Care Med, 153, pp.1469~1471 (1996)
- Wilson NM, "Atopy, bronchial responsiveness, and symptoms in wheezy 3 year olds", Arch Dis Child, 67, pp.491~495 (1992)
- Crane J, "The relationships between atopy, bronchial hyperresponsiveness, and a family history of asthma: a cross-sectional study of migrant Tokelauan children in New Zealand", J Allergy Clin Immunol, 84, pp.768~772 (1989)
- Kono M, "Age-dependent relationship between bronchial hyperresponsiveness to methacholine and total serum IgE level in asthmatic children", Ann Allergy Asthma Immunol, 87, pp.33~38 (2001)
- Bakirtas A, "Determinants of airway responsiveness to adenosine 5'-monophosphate in school-age children with asthma", Pediatr Pulmonol, 41, pp.515~521 (2006)
- Bakirtas A, "Airway hyper-responsiveness to adenosine 5'-monophosphate in preschool-age children with asthma", Pediatr Allergy Immunol, 17, pp.428~434 (2006)
- Barbee RA, "Allergen skin-test reactivity in a community population sample: correlation with age, histamine skin reactions and total serum immunoglobulin E", J Allergy Clin Immunol, 68, pp.15~19 (1981)
- Lee HB, "A study of serum total and house dust mite-specific IgE, and ECP levels in healthy Korean children under 7 years of age", Pediatr Allergy Respir Dis(Korean), 9, pp.157~166 (1999)
- Shimizu T, "Inhaled furosemide prevents ultrasonically nebulized water bronchoconstriction in children with both atopic and nonatopic asthma", Chest, 104, pp.1723~1726 (1993)
- Wenzel SE, "Activation of pulmonary mast cells by bronchoalveolar allergen challenge. In vivo release of histamine and tryptase in atopic subjects with and without asthma", Am Rev Respir Dis, 137, pp.1002~1008 (1988)
- Mochizuki H, "Bronchial hyperresponsiveness in children with atopic and nonatopic asthma", J Asthma, 24, pp.75~80 (1987)
- Peachell PT, "Adenosine potentiates mediator release from human lung mast cells", Am Rev Respir Dis, 138, pp.1143~1151 (1988)