Browse > Article
http://dx.doi.org/10.3904/kjm.2012.83.5.598

Is It Necessary to Re-Evaluate Airway Hyperresponsiveness During Treatment of Mild Asthma?  

Lee, Jong Hoo (Department of Internal Medicine, Jeju National University School of Medicine)
Lee, Jaechun (Department of Internal Medicine, Jeju National University School of Medicine)
Publication Information
The Korean Journal of Medicine / v.83, no.5, 2012 , pp. 598-605 More about this Journal
Abstract
Background/Aims: Airway hyperresponsiveness (AHR) is one of the typical characteristics of asthma. However, its natural course is unknown. The presence of AHR is often not assessed in asthmatics undergoing medical treatment. We investigated the changes of AHR as compared with clinical parameters in patients with mild asthma. Methods: We enrolled patients who were diagnosed with asthma, but were asymptomatic for > 3 months while undergoing medical treatment. AHR was measured using a methacholine bronchial provocation test after a 2-week washout period. AHR-negativity was defined as a $PC_{20}$ > 25 mg/mL. Clinical parameters were retrospectively compared between the AHR-negative and -positive patients. Results: Among 54 patients, 22 (40.7%) were AHR negative. Factors associated with the maintenance of AHR were male sex, presence of dyspnea, and high-dose inhaled corticosteroid plus long-acting beta agonists at initial presentation (respectively, p < 0.05). Age, symptoms other than dyspnea, blood tests, results of spirometry, diagnostic methods at presentation, and time from diagnosis to follow-up testing were not significantly different between AHR-negative and AHR-positive patients. Multivariate analyses failed to show a significant difference between the two groups, except for male sex (p = 0.014). Conclusions: Approximately 40% of patients with mild asthma show no AHR or clinical remission of the disease. Male sex may be a predictive factor for persistent AHR. However, altered AHR status is not predictable in patients with mild asthma undergoing medical treatment. Therefore, the cessation of regular controller might be advocated, and reassessment of AHR should be mandatory.
Keywords
Asthma; Bronchial hyperreactivity; Bronchial provocation tests; Methacholine chloride;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 The Global Initiative for Asthma. GINA Report: global strategy for asthma management and prevention [Internet]. The Global Initiative for Asthma, c2011 [cited 2011 December 28]. Available from: http://www.ginasthma.org.
2 O'Byrne PM, Barnes PJ, Rodriguez-Roisin R, et al. Low dose inhaled budesonide and formoterol in mild persistent asthma: the OPTIMA randomized trial. Am J Respir Crit Care Med 2001;164(8 Pt 1):1392-1397.
3 Haahtela T, Jarvinen M, Kava T, et al. Effects of reducing or discontinuing inhaled budesonide in patients with mild asthma. N Engl J Med 1994;331:700-705.   DOI   ScienceOn
4 Selroos O, Pietinalho A, Löfroos AB, Riska H. Effect of early vs late intervention with inhaled corticosteroids in asthma. Chest 1995;108:1228-1234.   DOI   ScienceOn
5 Stoloff SW, Stempel DA, Meyer J, Stanford RH, Carranza Rosenzweig JR. Improved refill persistence with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies. J Allergy Clin Immunol 2004;113:245-251.   DOI   ScienceOn
6 Boushey HA, Sorkness CA, King TS, et al. Daily versus as-needed corticosteroids for mild persistent asthma. N Engl J Med 2005;352:1519-1528.   DOI   ScienceOn
7 Jeon BH, Lee JC, Kim JH, Kim JW, Lee HS, Lee KH. Atopy and sensitization rates to aeroallergens in children and teenagers in Jeju, Korea. Korean J Asthma Allergy Clin Immunol 2010;30:14-20.
8 Cockcroft DW. Direct challenge tests: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest 2010;138(2 Suppl):18S-24S.
9 O'Byrne PM, Gauvreau GM, Brannan JD. Provoked models of asthma: what have we learnt? Clin Exp Allergy 2009;39:181-192.   DOI   ScienceOn
10 Ramsdale EH, Roberts RS, Morris MM, Hargreave FE. Differences in responsiveness to hyperventilation and methacholine in asthma and chronic bronchitis. Thorax 1985;40:422-426.   DOI   ScienceOn
11 Verma VK, Cockcroft DW, Dosman JA. Airway responsiveness to inhaled histamine in chronic obstructive airways disease: chronic bronchitis vs emphysema. Chest 1988;94:457-461.   DOI   ScienceOn
12 Cockcroft DW, Murdock KY, Berscheid BA, Gore BP. Sensitivity and specificity of histamine PC20 determination in a random selection of young college students. J Allergy Clin Immunol 1992;89(1 Pt 1):23-30.
13 Cockcroft DW, Davis BE. Mechanisms of airway hyperresponsiveness. J Allergy Clin Immunol 2006;118:551-559.   DOI   ScienceOn
14 Busse WW. The relationship of airway hyperresponsiveness and airway inflammation: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest 2010;138(2 Suppl):4S-10S.
15 Sont JK, Willems LN, Bel EH, van Krieken JH, Vandenbroucke JP, Sterk PJ. Clinical control and histopathologic outcome of asthma when using airway hyperresponsiveness as an additional guide to long-term treatment: the AMPUL Study Group. Am J Respir Crit Care Med 1999;159(4 Pt 1):1043-1051.
16 Koh YY, Kang EK, Kang H, Yoo Y, Park Y, Kim CK. Bronchial hyperresponsiveness in adolescents with longterm asthma remission: importance of a family history of bronchial hyperresponsiveness. Chest 2003;124:819-825.   DOI   ScienceOn
17 Hanxiang N, Jiong Y, Yanwei C, et al. Persistent airway inflammation and bronchial hyperresponsiveness in patients with totally controlled asthma. Int J Clin Pract 2008;62:599-605.
18 Park S, Lee YW, Park JW, Hong CS. Clinical characteristics of bronchial asthmatics who showed negative conversion of airway hyperreactivity in the methacholine provocation test. Korean J Asthma Allergy Clin Immunol 2008;28:20-25.