Methacholine bronchial provocation test in patients with asthma: serial measurements and clinical significance
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Background/Aims: The methacholine bronchial provocation test (MBPT) is used to detect and quantify airway hyper-responsiveness (AHR). Since improvements in the severity of asthma are associated with improvements in AHR, clinical studies of asthma therapies routinely use the change of airway responsiveness as an objective outcome. The aim of this study was to assess the relationship between serial MBPT and clinical profiles in patients with asthma. Methods: A total of 323 asthma patients were included in this study. The MBPT was performed on all patients beginning at their initial diagnosis until asthma was considered controlled based on the Global Initiative for Asthma guidelines. A responder was defined by a decrease in AHR while all other patients were considered non-responders. Results: A total of 213 patients (66%) were responders, while 110 patients (34%) were non-responders. The responder group had a lower initial PC20 (provocative concentration of methacholine required to decrease the forced expiratory volume in 1 second by 20%) and longer duration compared to the non-responder group. Members of the responder group also had superior qualities of life, compared to members of the non-responder group. Whole blood cell counts were not related to differences in PC20; however, eosinophil concentration was. No differences in sex, age, body mass index, smoking history, serum immunoglobulin E, or frequency of acute exacerbation were observed between responders and non-responders. Conclusions: The initial PC20, the duration of asthma, eosinophil concentrations, and quality-of-life may be useful variables to identify improvements in AHR in asthma patients.
Abstract
Background/Aims: The methacholine bronchial provocation test (MBPT) is used to detect and quantify airway hyper-responsiveness (AHR). Since improvements in the severity of asthma are associated with improvements in AHR, clinical studies of asthma therapies routinely use the change of airway responsiveness as an objective outcome. The aim of this study was to assess the relationship between serial MBPT and clinical profiles in patients with asthma. Methods: A total of 323 asthma patients were included in this study. The MBPT was performed on all patients beginning at their initial diagnosis until asthma was considered controlled based on the Global Initiative for Asthma guidelines. A responder was defined by a decrease in AHR while all other patients were considered non-responders. Results: A total of 213 patients (66%) were responders, while 110 patients (34%) were non-responders. The responder group had a lower initial PC20 (provocative concentration of methacholine required to decrease the forced expiratory volume in 1 second by 20%) and longer duration compared to the non-responder group. Members of the responder group also had superior qualities of life, compared to members of the non-responder group. Whole blood cell counts were not related to differences in PC20; however, eosinophil concentration was. No differences in sex, age, body mass index, smoking history, serum immunoglobulin E, or frequency of acute exacerbation were observed between responders and non-responders. Conclusions: The initial PC20, the duration of asthma, eosinophil concentrations, and quality-of-life may be useful variables to identify improvements in AHR in asthma patients.
참고문헌 (33)
- Reddel HK, "A summary of the new GINA strategy: a roadmap to asthma control", Eur Respir J, 46, pp.622~639 (2015)[DOI]
- Brannan JD, "Airway hyperresponsiveness in asthma: mechanisms, clinical significance, and treatment", Front Physiol, 3, pp.460~ (2012)
- Cockcroft DW, "Bronchial reactivity to inhaled histamine: a method and clinical survey", Clin Allergy, 7, pp.235~243 (1977)[DOI]
- Sumino K, "Methacholine challenge test: diagnostic characteristics in asthmatic patients receiving controller medications", J Allergy Clin Immunol, 130, pp.69~75 (2012)[DOI]
- Crapo RO, "Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999", Am J Respir Crit Care Med, 161, pp.309~329 (2000)[DOI]
- Juniper EF, "Airway responsiveness to histamine and methacholine: relationship to minimum treatment to control symptoms of asthma", Thorax, 36, pp.575~579 (1981)[DOI]
- Murray AB, "Airway responsiveness to histamine as a test for overall severity of asthma in children", J Allergy Clin Immunol, 68, pp.119~124 (1981)[DOI]
- 송우정, "Challenges in the Management of Asthma in the Elderly", Allergy, Asthma & Immunology Research, 7(5), pp.431~439 (2015), 대한천식알레르기학회
- Kerrebijn KF, "Effect of long-term treatment with inhaled corticosteroids and beta-agonists on the bronchial responsiveness in children with asthma", J Allergy Clin Immunol, 79, pp.653~659 (1987)[DOI]
- Dinh Xuan A, "Use of non-specific bronchial challenges in the assessment of anti-asthmatic drugs", Eur Respir Rev, 1, pp.19~24 (1991)
- Crimi N, "Protective effects of inhaled ipratropium bromide on bronchoconstriction induced by adenosine and methacholine in asthma", Eur Respir J, 5, pp.560~565 (1992)
- Laitinen LA, "A comparative study of the effects of an inhaled corticosteroid, budesonide, and a beta 2-agonist, terbutaline, on airway inflammation in newly diagnosed asthma: a randomized, double-blind, parallel-group controlled trial", J Allergy Clin Immunol, 90, pp.32~42 (1992)[DOI]
- van Essen-Zandvliet EE, "Effects of 22 months of treatment with inhaled corticosteroids and", or beta-2-agonists on lung function, airway responsiveness, and symptoms in children with asthma. The Dutch Chronic Non-specific Lung Disease Study Group, 1992, pp.146, 547~554
- Rabe KF, "Comparison of the effects of salmeterol and formoterol on airway tone and responsiveness over 24 hours in bronchial asthma", Am Rev Respir Dis, 147, pp.1436~1441 (1993)[DOI]
- Prieto L, "Effect of inhaled budesonide on seasonal changes in sensitivity and maximal response to methacholine in pollen-sensitive asthmatic subjects", Eur Respir J, 7, pp.1845~1851 (1994)[DOI]
- Cockcroft DW, "Interaction of inhaled beta 2 agonist and inhaled corticosteroid on airway responsiveness to allergen and methacholine", Am J Respir Crit Care Med, 152, pp.1485~1489 (1995)[DOI]
- Bateman ED, "Global strategy for asthma management and prevention: GINA executive summary", Eur Respir J, 31, pp.143~178 (2008)[DOI]
- 장안수, "Impact of Atopy on Asthma and Allergic Rhinitis in the Cohort for Reality and Evolution of Adult Asthma in Korea", Allergy, Asthma & Immunology Research, 5(3), pp.143~149 (2013), 대한천식알레르기학회
- Adams KF, "Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old", N Engl J Med, 355, pp.763~778 (2006)[DOI]
- McGee DL, "Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies", Ann Epidemiol, 15, pp.87~97 (2005)[DOI]
- Juniper EF, "Determining a minimal important change in a disease-specific Quality of Life Questionnaire", J Clin Epidemiol, 47, pp.81~87 (1994)[DOI]
- Chai H, "Standardization of bronchial inhalation challenge procedures", J Allergy Clin Immunol, 56, pp.323~327 (1975)[DOI]
- Cockcroft D, "Direct and indirect challenges in the clinical assessment of asthma", Ann Allergy Asthma Immunol, 103, pp.363~369 (2009)[DOI]
- Sont JK, "Relationship between the inflammatory infiltrate in bronchial biopsy specimens and clinical severity of asthma in patients treated with inhaled steroids", Thorax, 51, pp.496~502 (1996)[DOI]
- Petsky HL, "A systematic review and meta-analysis: tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils)", Thorax, 67, pp.199~208 (2012)[DOI]
- 김효빈, "Exhaled NO: Determinants and Clinical Application in Children With Allergic Airway Disease", Allergy, Asthma & Immunology Research, 8(1), pp.12~21 (2016), 대한천식알레르기학회
- British Thoracic Society Scottish Intercollegiate Guidelines Network, "British guideline on the management of asthma", Thorax, 63(Suppl 4), pp.iv1~iv121 (2008)[DOI]
- Reddel HK, "An official American Thoracic Society", European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice, 2009, pp.180, 59~99
- Cockcroft DW, "Mechanisms of airway hyperresponsiveness", J Allergy Clin Immunol, 118, pp.551~559 (2006)[DOI]
- Zacharasiewicz A, "Clinical use of noninvasive measurements of airway inflammation in steroid reduction in children", Am J Respir Crit Care Med, 171, pp.1077~1082 (2005)[DOI]
- Korevaar DA, "Diagnostic accuracy of minimally invasive markers for detection of airway eosinophilia in asthma: a systematic review and meta-analysis", Lancet Respir Med, 3, pp.290~300 (2015)[DOI]
- Juniper EF, "Measurement properties and interpretation of three shortened versions of the asthma control questionnaire", Respir Med, 99, pp.553~558 (2005)[DOI]
- Thomas M, "The Asthma Control Test (ACT) as a predictor of GINA guideline-defined asthma control: analysis of a multinational cross-sectional survey", Prim Care Respir J, 18, pp.41~49 (2009)[DOI]
