The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Methacholine bronchial provocation test in patients with asthma: serial measurements and clinical significance

  • Seo, Hyun-Jung (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Pureun-Haneul (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Byeong-Gon (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Sun-Hye (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Park, Jong-Sook (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Junehyuck (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Park, Sung-Woo (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Do-Jin (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Park, Choon-Sik (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Jang, An-Soo (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital)
  • Received : 2017.01.25
  • Accepted : 2017.06.24
  • Published : 2018.07.01
⟨ Previous Next ⟩

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 $PC_{20}$ (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 $PC_{20}$; 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 $PC_{20}$, the duration of asthma, eosinophil concentrations, and quality-of-life may be useful variables to identify improvements in AHR in asthma patients.

Keywords

Acknowledgement

Supported by : Korea Health Industry Development Institute (KHIDI), Soonchunhyang University

References

  1. Reddel HK, Bateman ED, Becker A, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J 2015;46:622-639. https://doi.org/10.1183/13993003.00853-2015
  2. Brannan JD, Lougheed MD. Airway hyperresponsiveness in asthma: mechanisms, clinical significance, and treatment. Front Physiol 2012;3:460.
  3. Cockcroft DW, Killian DN, Mellon JJ, Hargreave FE. Bronchial reactivity to inhaled histamine: a method and clinical survey. Clin Allergy 1977;7:235-243. https://doi.org/10.1111/j.1365-2222.1977.tb01448.x
  4. Sumino K, Sugar EA, Irvin CG, et al. Methacholine challenge test: diagnostic characteristics in asthmatic patients receiving controller medications. J Allergy Clin Immunol 2012;130:69-75. https://doi.org/10.1016/j.jaci.2012.02.025
  5. Crapo RO, Casaburi R, Coates AL, et al. 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 2000;161:309-329. https://doi.org/10.1164/ajrccm.161.1.ats11-99
  6. Juniper EF, Frith PA, Hargreave FE. Airway responsiveness to histamine and methacholine: relationship to minimum treatment to control symptoms of asthma. Thorax 1981;36:575-579. https://doi.org/10.1136/thx.36.8.575
  7. Murray AB, Ferguson AC, Morrison B. Airway responsiveness to histamine as a test for overall severity of asthma in children. J Allergy Clin Immunol 1981;68:119-124. https://doi.org/10.1016/0091-6749(81)90169-X
  8. Song WJ, Cho SH. Challenges in the management of asthma in the elderly. Allergy Asthma Immunol Res 2015;7:431-439. https://doi.org/10.4168/aair.2015.7.5.431
  9. Kerrebijn KF, van Essen-Zandvliet EE, Neijens HJ. Effect of long-term treatment with inhaled corticosteroids and beta-agonists on the bronchial responsiveness in children with asthma. J Allergy Clin Immunol 1987;79:653-659. https://doi.org/10.1016/S0091-6749(87)80163-X
  10. Dinh Xuan A, Lockart A. Use of non-specific bronchial challenges in the assessment of anti-asthmatic drugs. Eur Respir Rev 1991;1:19-24.
  11. Crimi N, Palermo F, Oliveri R, Polosa R, Settinieri I, Mistretta A. Protective effects of inhaled ipratropium bromide on bronchoconstriction induced by adenosine and methacholine in asthma. Eur Respir J 1992;5:560-565.
  12. Laitinen LA, Laitinen A, Haahtela T. 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 1992;90:32-42. https://doi.org/10.1016/S0091-6749(06)80008-4
  13. van Essen-Zandvliet EE, Hughes MD, Waalkens HJ, et al. 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. Am Rev Respir Dis 1992;146:547-554. https://doi.org/10.1164/ajrccm/146.3.547
  14. Rabe KF, Jorres R, Nowak D, Behr N, Magnussen H. Comparison of the effects of salmeterol and formoterol on airway tone and responsiveness over 24 hours in bronchial asthma. Am Rev Respir Dis 1993;147:1436-1441. https://doi.org/10.1164/ajrccm/147.6_Pt_1.1436
  15. Prieto L, Berto JM, Gutierrez V, Tornero C. Effect of inhaled budesonide on seasonal changes in sensitivity and maximal response to methacholine in pollen-sensitive asthmatic subjects. Eur Respir J 1994;7:1845-1851. https://doi.org/10.1183/09031936.94.07101845
  16. Cockcroft DW, Swystun VA, Bhagat R. Interaction of inhaled beta 2 agonist and inhaled corticosteroid on airway responsiveness to allergen and methacholine. Am J Respir Crit Care Med 1995;152:1485-1489. https://doi.org/10.1164/ajrccm.152.5.7582281
  17. Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008;31:143-178. https://doi.org/10.1183/09031936.00138707
  18. Jang AS, Kim SH, Kim TB, et al. Impact of atopy on asthma and allergic rhinitis in the cohort for reality and evolution of adult asthma in Korea. Allergy Asthma Immunol Res 2013;5:143-149. https://doi.org/10.4168/aair.2013.5.3.143
  19. Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006;355:763-778. https://doi.org/10.1056/NEJMoa055643
  20. McGee DL; Diverse Populations Collaboration. Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol 2005;15:87-97. https://doi.org/10.1016/j.annepidem.2004.05.012
  21. Juniper EF, Guyatt GH, Willan A, Griffith LE. Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol 1994;47:81-87. https://doi.org/10.1016/0895-4356(94)90036-1
  22. Chai H, Farr RS, Froehlich LA, et al. Standardization of bronchial inhalation challenge procedures. J Allergy Clin Immunol 1975;56:323-327. https://doi.org/10.1016/0091-6749(75)90107-4
  23. Cockcroft D, Davis B. Direct and indirect challenges in the clinical assessment of asthma. Ann Allergy Asthma Immunol 2009;103:363-369. https://doi.org/10.1016/S1081-1206(10)60353-5
  24. Sont JK, Han J, van Krieken JM, et al. Relationship between the inflammatory infiltrate in bronchial biopsy specimens and clinical severity of asthma in patients treated with inhaled steroids. Thorax 1996;51:496-502. https://doi.org/10.1136/thx.51.5.496
  25. Petsky HL, Cates CJ, Lasserson TJ, et al. A systematic review and meta-analysis: tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils). Thorax 2012;67:199-208. https://doi.org/10.1136/thx.2010.135574
  26. Kim HB, Eckel SP, Kim JH, Gilliland FD. Exhaled NO: determinants and clinical application in children with allergic airway disease. Allergy Asthma Immunol Res 2016;8:12-21. https://doi.org/10.4168/aair.2016.8.1.12
  27. British Thoracic Society Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. Thorax 2008;63 Suppl 4:iv1-iv121. https://doi.org/10.1136/thx.2008.097741
  28. Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 2009;180:59-99. https://doi.org/10.1164/rccm.200801-060ST
  29. Cockcroft DW, Davis BE. Mechanisms of airway hyperresponsiveness. J Allergy Clin Immunol 2006;118:551-559. https://doi.org/10.1016/j.jaci.2006.07.012
  30. Zacharasiewicz A, Wilson N, Lex C, et al. Clinical use of noninvasive measurements of airway inflammation in steroid reduction in children. Am J Respir Crit Care Med 2005;171:1077-1082. https://doi.org/10.1164/rccm.200409-1242OC
  31. Korevaar DA, Westerhof GA, Wang J, et al. Diagnostic accuracy of minimally invasive markers for detection of airway eosinophilia in asthma: a systematic review and meta-analysis. Lancet Respir Med 2015;3:290-300. https://doi.org/10.1016/S2213-2600(15)00050-8
  32. Juniper EF, Svensson K, Mork AC, Stahl E. Measurement properties and interpretation of three shortened versions of the asthma control questionnaire. Respir Med 2005;99:553-558. https://doi.org/10.1016/j.rmed.2004.10.008
  33. Thomas M, Kay S, Pike J, et al. 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 2009;18:41-49. https://doi.org/10.4104/pcrj.2009.00010

Cited by

  1. An in vivo image acquisition system for the evaluation of tracheal mechanics in rats vol.44, pp.5, 2018, https://doi.org/10.1111/aor.13604