Diagnostic and Therapeutic Value of Airway Challenges in Asthma

Overview

Journal Curr Allergy Asthma Rep

Specialties Allergy & Immunology
Pulmonary Medicine

Date 2009 Apr 8

PMID 19348726

Citations 7

Authors

Donald W Cockcroft

Beth E Davis

Affiliations

Soon will be listed here.

Abstract

Airway challenges are of value in the assessment of asthma. Direct challenges (histamine and methacholine) are highly sensitive for clinically current symptomatic asthma and particularly useful to exclude current asthma when they are negative. Indirect challenges (exercise, eucapnic voluntary hyperventilation, adenosine monophosphate, hypertonic saline, mannitol) are more specific but very insensitive for clinical asthma. They are of particular value to confirm asthma and to differentiate asthma from other airway diseases, such as chronic airflow limitation. The indirect stimuli are the challenges of choice for evaluating exercise-induced bronchoconstriction.

Citing Articles

Application of a Cold Dry Air Provocation Test in Pediatric Patients with Asthma.

Ahn J, Choi B Children (Basel). 2022; 9(6).

PMID: 35740856 PMC: 9222104. DOI: 10.3390/children9060920.

Use of Symptoms Scores, Spirometry, and Other Pulmonary Function Testing for Asthma Monitoring.

Gallucci M, Carbonara P, Pacilli A, Di Palmo E, Ricci G, Nava S Front Pediatr. 2019; 7:54.

PMID: 30891435 PMC: 6413670. DOI: 10.3389/fped.2019.00054.

Diagnostic work-up in patients with possible asthma referred to a university hospital.

Backer V, Sverrild A, Ulrik C, Bodtger U, Seersholm N, Porsbjerg C Eur Clin Respir J. 2015; 2.

PMID: 26557251 PMC: 4629726. DOI: 10.3402/ecrj.v2.27768.

Exhaled nitric oxide is related to atopy, but not asthma in adolescents with bronchiolitis in infancy.

Bruun Mikalsen I, Halvorsen T, Oymar K BMC Pulm Med. 2013; 13:66.

PMID: 24237793 PMC: 3840648. DOI: 10.1186/1471-2466-13-66.

Relationship of mannitol challenge to methacholine challenge and inflammatory markers in persistent asthmatics receiving inhaled corticosteroids.

Anderson W, Lipworth B Lung. 2012; 190(5):513-21.

PMID: 22684880 DOI: 10.1007/s00408-012-9396-6.

References

Adelroth E, Hargreave F, Ramsdale E . Do physicians need objective measurements to diagnose asthma?. Am Rev Respir Dis. 1986; 134(4):704-7. DOI: 10.1164/arrd.1986.134.4.704. View

Porsbjerg C, Rasmussen L, Thomsen S, Brannan J, Anderson S, Backer V . Response to mannitol in asymptomatic subjects with airway hyper-responsiveness to methacholine. Clin Exp Allergy. 2007; 37(1):22-8. DOI: 10.1111/j.1365-2222.2006.02614.x. View

Gibson P, Dolovich J, Denburg J, Ramsdale E, Hargreave F . Chronic cough: eosinophilic bronchitis without asthma. Lancet. 1989; 1(8651):1346-8. DOI: 10.1016/s0140-6736(89)92801-8. View

Holzer K, Anderson S, Chan H, Douglass J . Mannitol as a challenge test to identify exercise-induced bronchoconstriction in elite athletes. Am J Respir Crit Care Med. 2002; 167(4):534-7. DOI: 10.1164/rccm.200208-916OC. View

van den Berge M, Kerstjens H, Meijer R, de Reus D, Koeter G, Kauffman H . Corticosteroid-induced improvement in the PC20 of adenosine monophosphate is more closely associated with reduction in airway inflammation than improvement in the PC20 of methacholine. Am J Respir Crit Care Med. 2001; 164(7):1127-32. DOI: 10.1164/ajrccm.164.7.2102135. View

van den Berge M, Meijer R, Kerstjens H, de Reus D, Koeter G, Kauffman H . PC(20) adenosine 5'-monophosphate is more closely associated with airway inflammation in asthma than PC(20) methacholine. Am J Respir Crit Care Med. 2001; 163(7):1546-50. DOI: 10.1164/ajrccm.163.7.2010145. View

Green R, Brightling C, McKenna S, Hargadon B, Parker D, Bradding P . Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet. 2002; 360(9347):1715-21. DOI: 10.1016/S0140-6736(02)11679-5. View

IRWIN R, French C, Smyrnios N, CURLEY F . Interpretation of positive results of a methacholine inhalation challenge and 1 week of inhaled bronchodilator use in diagnosing and treating cough-variant asthma. Arch Intern Med. 1997; 157(17):1981-7. View

Smith C, Anderson S . Inhalational challenge using hypertonic saline in asthmatic subjects: a comparison with responses to hyperpnoea, methacholine and water. Eur Respir J. 1990; 3(2):144-51. View

10.

Brannan J, Gulliksson M, Anderson S, Chew N, Seale J, Kumlin M . Inhibition of mast cell PGD2 release protects against mannitol-induced airway narrowing. Eur Respir J. 2006; 27(5):944-50. DOI: 10.1183/09031936.06.00078205. View

11.

Cockcroft D, Davis B, Todd D, Smycniuk A . Methacholine challenge: comparison of two methods. Chest. 2005; 127(3):839-44. DOI: 10.1378/chest.127.3.839. View

12.

Cartier A, Pineau L, Malo J . Monitoring of maximum expiratory peak flow rates and histamine inhalation tests in the investigation of occupational asthma. Clin Allergy. 1984; 14(2):193-6. DOI: 10.1111/j.1365-2222.1984.tb02652.x. View

13.

Crapo R, Casaburi R, Coates A, Enright P, Hankinson J, Irvin C . 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(1):309-29. DOI: 10.1164/ajrccm.161.1.ats11-99. View

14.

Cockcroft D, Davis B . The bronchoprotective effect of inhaling methacholine by using total lung capacity inspirations has a marked influence on the interpretation of the test result. J Allergy Clin Immunol. 2006; 117(6):1244-8. DOI: 10.1016/j.jaci.2006.02.038. View

15.

Ramsdale E, Roberts R, Morris M, Hargreave F . Differences in responsiveness to hyperventilation and methacholine in asthma and chronic bronchitis. Thorax. 1985; 40(6):422-6. PMC: 460091. DOI: 10.1136/thx.40.6.422. View

16.

Todd D, Davis B, Hurst T, Cockcroft D . Dosimeter methacholine challenge: comparison of maximal versus submaximal inhalations. J Allergy Clin Immunol. 2004; 114(3):517-9. DOI: 10.1016/j.jaci.2004.06.016. View

17.

Cockcroft D, Berscheid B, Murdock K . Unimodal distribution of bronchial responsiveness to inhaled histamine in a random human population. Chest. 1983; 83(5):751-4. DOI: 10.1378/chest.83.5.751. View

18.

Polosa R, Holgate S . Adenosine bronchoprovocation: a promising marker of allergic inflammation in asthma?. Thorax. 1997; 52(10):919-23. PMC: 1758427. DOI: 10.1136/thx.52.10.919. View

19.

Cockcroft D, Killian D, Mellon J, Hargreave F . Bronchial reactivity to inhaled histamine: a method and clinical survey. Clin Allergy. 1977; 7(3):235-43. DOI: 10.1111/j.1365-2222.1977.tb01448.x. View

20.

Choi S, Kim D, Yu J, Yoo Y, Koh Y . Bronchial responsiveness to methacholine and adenosine 5'-monophosphate in young children with asthma: their relationship with blood eosinophils and serum eosinophil cationic protein. Allergy. 2007; 62(10):1119-24. DOI: 10.1111/j.1398-9995.2007.01412.x. View