Diagnostic value of fractional exhaled nitric oxide combined with small airway function test for chronic cough / 中国基层医药

Objective:To investigate the value of fractional exhaled nitric oxide (FeNO) combined with small airway function test to replace bronchial provocation test and induced sputum test in differentiating cough variant asthma (CVA) from eosinophilic bronchitis (EB).Methods:The clinical data of 105 patients with chronic cough admitted to The Third People's Hospital of Hubei, Jianghan University from January 2018 to December 2021 were retrospectively analyzed. These patients consisted of 40 patients with CVA (CVA group), 25 patients with EB (EB group), and 40 patients with other chronic coughs (other chronic cough group). FeNO and lung function were compared between groups. The value of FeNO, small airway function, and their combination in differentiating CVA from EB were analyzed using the receiver operating characteristic curves.Results:FeNO level was the highest in the CVA group [33.0 (30.0, 37.8) ppb], followed by the EB group [28.0 (25.5, 32.0) ppb], and the lowest in other chronic cough group [13.0 (11.0, 15.0) ppb]. There was significant difference in FeNO level between groups ( H value = 79.00, P < 0.05). There were no significant differences in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1), FEV 1/FVC, peak expiratory flow (PEF) between groups (all P > 0.05). Maximal mid-expiratory flow (MMEF) [74 (66.0, 77.4) in the CVA group, 80 (79.0, 83.3) in the EB group, 88.0 (86.4, 90.0) in other chronic coughs group], FEF25 (%) [70.0 (60.3, 75.1) in the CVA group, 78.0 (74.1, 85.0) in the EB group, 81.7 (78.9, 86.3) in other chronic coughs group], FEF50 (%) [75.2 (67.1, 80.8) in the CVA group, 80.6 (75.7, 85.9) in the EB group, 89.4 (87.0, 90.5) in other chronic coughs group], FEF75 (%) [76.4 (68.7, 85.8) in the CVA group, 80.9 (77.4, 89.7) in the EB group, 90.8 (87.2, 94.2) in other chronic coughs group] were significantly lower in the CVA group than those in other chronic coughs group. With the exception of FEF25 (%), MMEF (%), FEF50 (%), and FEF75 (%) were significantly lower in the EB group compared with other chronic coughs group. MMEF (%) and FEF25 (%) in the CVA group were significantly lower compared with the EB group. There were significant differences in MMEF (%), FEF50 (%), and FEF75 (%) between groups ( H = 62.82, 47.04, 47.41, 49.11, all P < 0.01). There were significant differences in FEF50 (%) and FEF75 (%) between CVA and EB groups (both P > 0.05). In binary logistic regression equation, FeNO and MMEF (%) were important indexes to distinguish CVA from EB ( P < 0.05). Bronchial provocation test and induced sputum test were used as the gold standard to distinguish CVA from EB. When FeNO and MMEF (%) were used separately to distinguish CVA from EB, the optimal threshold value was 30.0 ppb and 77.7 respectively, the area under the receiver operating characteristic curve was 0.77 and 0.82 respectively, the diagnostic sensitivity was 70% and 77.5% respectively, and the diagnostic specificity was 72% and 88% respectively. When FeNO and MMEF (%) were used in combination to distinguish CVA from EB, the area under the receiver operating characteristic curve was 0.89, and the diagnostic sensitivity and specificity was 75% and 96% respectively. Conclusion:FeNO and MMEF (%) can be used to distinguish CVA from EB. FeNO combined with MMEF (%) has a higher value in distinguishing CVA from EB than FeNO and MMEF alone.

Pulmonology approach in the investigation of chronic unexplained dyspnea / Abordagem pneumológica na investigação de dispneia crônica inexplicada

ABSTRACT Chronic unexplained dyspnea and exercise intolerance represent common, distressing symptoms in outpatients. Clinical history taking and physical examination are the mainstays for diagnostic evaluation. However, the cause of dyspnea may remain elusive even after comprehensive diagnostic evaluation-basic laboratory analyses; chest imaging; pulmonary function testing; and cardiac testing. At that point (and frequently before), patients are usually referred to a pulmonologist, who is expected to be the main physician to solve this conundrum. In this context, cardiopulmonary exercise testing (CPET), to assess physiological and sensory responses from rest to peak exercise, provides a unique opportunity to unmask the mechanisms of the underlying dyspnea and their interactions with a broad spectrum of disorders. However, CPET is underused in clinical practice, possibly due to operational issues (equipment costs, limited availability, and poor remuneration) and limited medical education regarding the method. To counter the latter shortcoming, we aspire to provide a pragmatic strategy for interpreting CPET results. Clustering findings of exercise response allows the characterization of patterns that permit the clinician to narrow the list of possible diagnoses rather than pinpointing a specific etiology. We present a proposal for a diagnostic workup and some illustrative cases assessed by CPET. Given that airway hyperresponsiveness and pulmonary vascular disorders, which are within the purview of pulmonology, are common causes of chronic unexplained dyspnea, we also aim to describe the role of bronchial challenge tests and the diagnostic reasoning for investigating the pulmonary circulation in this context.

RESUMO A dispneia crônica inexplicada e a intolerância ao exercício representam sintomas comuns e angustiantes em pacientes ambulatoriais. O histórico clínico e o exame físico são as bases da avaliação diagnóstica. No entanto, a causa da dispneia pode permanecer inexplicada mesmo após uma avaliação diagnóstica abrangente - análises laboratoriais básicas, exames de imagem do tórax, testes de função pulmonar e testes cardíacos. Nesse momento (e frequentemente antes), os pacientes geralmente são encaminhados a um pneumologista, o qual se espera que seja o principal médico para a resolução desse enigma. Nesse contexto, o teste de exercício cardiopulmonar (TECP), para avaliação de respostas fisiológicas e sensoriais do repouso ao pico do exercício, proporciona uma oportunidade única de desvendar os mecanismos subjacentes à dispneia e as interações desses mecanismos com um amplo espectro de distúrbios. No entanto, o TECP é subutilizado na prática clínica, possivelmente por questões operacionais (custos dos equipamentos, disponibilidade limitada e baixa remuneração) e limitação da formação médica em relação ao método. Para enfrentar esta última deficiência, almejamos fornecer uma estratégia pragmática para a interpretação dos resultados do TECP. O agrupamento dos achados da resposta ao exercício permite a caracterização de padrões que possibilitam ao clínico restringir a lista de possíveis diagnósticos, em vez de apontar uma etiologia específica. Apresentamos uma proposta de avaliação diagnóstica e alguns casos ilustrativos avaliados por TECP. Como a hiper-responsividade das vias aéreas e os distúrbios vasculares pulmonares, que são da competência da pneumologia, são causas comuns de dispneia crônica inexplicada, também objetivamos descrever o papel dos testes de broncoprovocação e o raciocínio diagnóstico para a investigação da circulação pulmonar nesse contexto.

Work-related asthma / Asma relacionada ao trabalho

ABSTRACT Work-related asthma (WRA) is highly prevalent in the adult population. WRA includes occupational asthma (OA), which is asthma caused by workplace exposures, and work-exacerbated asthma (WEA), also known as work-aggravated asthma, which is preexisting or concurrent asthma worsened by workplace conditions. In adults, the estimated prevalence of OA is 16.0%, whereas that of WEA is 21.5%. An increasing number of chemicals used in industrial production, households, and services are associated with the incidence of adult-onset asthma attributable to exposure to chemicals. This review article summarizes the different types of WRA and describes diagnostic procedures, treatment, prevention, and approaches to patient management. It is not always easy to distinguish between OA and WEA. It is important to establish a diagnosis (of sensitizer-/irritant-induced OA or WEA) in order to prevent worsening of symptoms, as well as to prevent other workers from being exposed, by providing early treatment and counseling on social security and work-related issues.

RESUMO A asma relacionada ao trabalho (ART) é um acometimento com elevada prevalência na população adulta. A ART inclui a asma ocupacional (AO), desencadeada pela exposição a um agente presente em um determinado ambiente de trabalho, e a asma agravada ou exacerbada pelo trabalho (AA/ET), que acomete indivíduos com antecedentes de asma ou que iniciaram um quadro de asma concomitante, mas sem relação causal com o ambiente de trabalho. Estima-se que 16,0% e 21,5% da asma no adulto sejam AO e AA/ET, respectivamente. O elevado e crescente número de substâncias químicas usadas na produção industrial, no uso domiciliar ou em serviços é responsável pela incidência de asma associada à exposição a agentes químicos na vida adulta. Este artigo de revisão descreve os principais tipos de ART, os procedimentos para seu diagnóstico, tratamento e prevenção e as condutas frente ao diagnóstico. Nem sempre é fácil a distinção entre AO e AA/ET. A importância do diagnóstico (AO ou AA/ET e asma induzida por sensibilizantes ou irritantes) tem relação com a adoção de medidas de prevenção para evitar que novos indivíduos sejam expostos e que os acometidos apresentem agravamento da doença, utilizando tratamento precoce e fornecendo orientação sobre aspectos previdenciários e trabalhistas.

Leukotriene D4 bronchial provocation test for detection of airway hyper-responsiveness in children / 南方医科大学学报

OBJECTIVE@#To explore the value of leukotriene D4 (LTD4) bronchial provocation test (BPT) in detection of airway hyper-responsiveness (AHR) in children.@*METHODS@#A total of 151 children aged 6 to 14 years, including 86 in remission of asthma and 65 with acute bronchitis, who were followed up in our respiratory clinic between November, 2017 and August, 2018. The children were randomly divided into LTD4 group (78 cases) and methacholine (MCH) group (73 cases). In LTD4 group, the 78 children underwent LTD4-BPT, including 46 with asthma and 32 children having re-examination for previous episodes of acute bronchitis; in MCH group, the 73 children underwent MCH-BPT, including 40 with asthma and 33 with acute bronchitis. MCH-BPT was also performed in the asthmatic children in the LTD4 group who had negative responses to LTD4 after an elution period. The major adverse reactions of the children to the two BPT were recorded. The diagnostic values of the two BPT were evaluated using receiver-operating characteristic (ROC) curve.@*RESULTS@#There was no significant difference in the results of basic lung function tests between LTD4 group and MCH group (>0.05). The positive rate of BPT in asthmatic children in the LTD4 group was significantly lower than that in the MCH group (26.1% 72.5%; < 0.05). The positive rate of BPT in children with previous acute bronchitis in the LTD4 group was lower than that in the MCH group (3.1% 15.2%). The positive rate of MCH-BPT in asthmatic children had negative BPT results in LTD4 group was 58.8%, and their asthma was mostly mild. The sensitivity was lower in LTD4 group than in MCH group (0.2609 0.725), but the specificity was slightly higher in LTD4 group (0.9688 vs 0.8485).The area under ROC curvein LTD4 group was lower than that in MCH group (0.635 0.787). In children with asthma in the LTD4 group, the main adverse reactions in BPT included cough (34.8%), shortness of breath (19.6%), chest tightness (15.2%), and wheezing (10.9%). The incidence of these adverse reactions was significantly lower in LTD4 group than in MCH group ( < 0.05). Serious adverse reactions occurred in neither of the two groups.@*CONCLUSIONS@#LTD4-BPT had high safety in clinical application of children and was similar to the specificity of MCH-BPT. However, it had low sensitivity, low diagnostic value, and limited application value in children's AHR detection.

Actualización de la prueba de provocación bronquial con ejercicio (PPBE) / Update of the bronchial provocation test with exercise

The bronchial challenge test with exercise aims to demonstrate the presence of exercise-induced bronchial hyperreactivity, characteristic of bronchial asthma. Its realization is well standardized, requiring special environmental conditions, preparation and submaximum effort of the patient. The response is measured by spirometry, and it is considered a positive exercise test a drop in the expired volume at the first second (FEV1) of 10%. This article describes the elements necessary to facilitate this exam, according to national and international standards and guidelines.

La prueba de provocación bronquial con ejercicio tiene como objetivo demostrar la presencia de hiperreactividad bronquial inducida por ejercicio, característica del asma bronquial. Su realización está bien estandarizada, requiriendo de condiciones ambientales especiales, preparación y esfuerzo submáximo del paciente. La respuesta se mide mediante espirometría, y se considera una prueba de provocación con ejercicio positivo, a una caída del volumen espirado al primer segundo (VEF1) del 10%. En este artículo se describen los elementos necesarios para facilitar la realización de este examen, acorde a normas y guías nacionales e internacionales.

Dyspnea Perception During Induced Bronchoconstriction Is Complicated by the Inhaled Methacholine in Children With Clinical Asthma

PURPOSE: Dyspnea is not widely utilized as an indicator of asthma provocation despite its universal presentation. We hypothesized that dyspnea severity was proportionate with the lung function decline, methacholine dose-step, and the degree of bronchial hyperresponsiveness (BHR). METHODS: We retrospectively analyzed 73 children's bronchial provocation test data with an assessment of dyspnea at every dose-step. Dyspnea severity was scored using a modified Borg (mBorg) scale. A linear mixed effect analysis was performed to evaluate the relationship between the mBorg scale, the percentage fall in the forced expiratory volume in 1 second (FEV1) (ΔFEV1%), the methacholine dose-step, and the degree of BHR (BHR grade). RESULTS: Subjects were divided into 5 BHR groups based on their last methacholine dose-steps. The mBorg scores did not differ significantly among BHR groups (P=0.596, Kruskal-Wallis test). The linear mixed effect analysis showed that ΔFEV1% was affected by the methacholine dose-step (P < 0.001) and BHR grade (P < 0.001). The mBorg score was affected by the dose-step (P < 0.001) and BHR grade (P=0.019). We developed a model to predict the mBorg score and found that it was affected by the methacholine dose-step and ΔFEV1%, elevating it by a score of 0.039 (χ² [1]=21.06, P < 0.001) and 0.327 (χ² [1]=47.45, P < 0.001), respectively. A significant interaction was observed between the methacholine dose-step and ΔFEV1% (χ² [1]=16.20, P < 0.001). CONCLUSIONS: In asthmatic children, inhaled methacholine, as well as the degree of BHR and lung function decline, may affect dyspnea perception during the bronchial provocation test. If we wish to draw meaningful information from dyspnea perception, we have to consider various complicating factors underlying it.

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

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.

The KAAACI Standardization Committee Report on the procedure and application of the bronchial provocation tests

Bronchial provocation tests are of value in the evaluation of airway hyperresponsiveness. Nonspecific bronchial challenge (methacholine, mannitol, exercise, etc.) is used when the symptoms, physical examination, and measurements of pulmonary function are unremarkable in the diagnosis of asthma, when a patient is suspected of having occupational asthma or exercise-induced bronchoconstriction (EIB), and when a screening test for asthma or EIB is required for some occupational groups in whom bronchospasm would pose an unacceptable hazard. Methacholine inhalation challenge is most widely used pharmacologic challenge and highly sensitive. For appropriate interpretation of the results of methacholine provocation, it is important to perform the test with the standardized protocol and to recognize that inhalation methods significantly influence the sensitivity of the procedure. Indirect challenges (e.g., mannitol and exercise) correlate with airway inflammation and are more specific but less sensitive for asthma. Indirect provocation tests are used to confirm asthma, to differentiate asthma from other airway diseases, and to evaluate EIB.

Nonspecific Bronchoprovocation Test / 결핵및호흡기질환

Bronchial asthma is a disease characterized by the condition of airway hyper-responsiveness, which serves to produce narrowing of the airway secondary to airway inflammation and/or various spasm-inducing stimulus. Nonspecific bronchoprovocation testing is an important method implemented for the purpose of diagnosing asthma; this test measures the actual degree of airway hyper-responsiveness and utilizes direct and indirect bronchoprovocation testing. Direct bronchoprovocation testing using methacholine or histamine may have superior sensitivity as these substances directly stimulate the airway smooth muscle cells. On the other hand, this method also engenders the specific disadvantage of relatively low specificity. Indirect bronchoprovocation testing using mannitol, exercise, hypertonic saline, adenosine and hyperventilation serves to produce reactions in the airway smooth muscle cells by liberating mediators with stimulation of airway inflammatory cells. Therefore, this method has the advantage of high specificity and also demonstrates relatively low sensitivity. Direct and indirect testing both call for very precise descriptions of very specific measurement conditions. In addition, it has become evident that challenge testing utilizing each of the various bronchoconstrictor stimuli requires distinct and specific protocols. It is therefore important that the clinician understand the mechanism by which the most commonly used bronchoprovocation testing works. It is important that the clinician understand the mechanism of action in the testing, whether direct stimuli (methacholine) or indirect stimuli (mannitol, exercise) is implemented, when the testing is performed and the results interpreted.

Comparison on the profiles of a modified Borg scale and the pediatric dyspnea scale during an induced bronchoconstriction in children with clinical asthma

PURPOSE: Dyspnea is the cardinal symptom of asthma, but it is difficult to quantify clinically. Although modified Borg (mBorg) scale has been successfully used in adult, but there has been some difficulties to apply in children. Recently, Pediatric Dyspnea Scale (PDS) was adequately designed and has been widely used. The aim of this study is to compare 2 evaluating scales of dyspnea provoked by induced-bronchoconstriction in childhood asthma. METHODS: Seventy-three clinically suspected children with asthma were enrolled in this study. Each ‘fractional exhaled nitric oxide (FeNO)’ was documented. Forced expiratory volume in 1 second (FEV₁), mBorg score and PDS score were recorded during methacholine provocation test. RESULTS: Mapping using canonical plot demonstrated global similarity between 2 scales with some distinctive features. Whereas mBorg score showed more diverse categories in low level of dyspnea, PDS score did in medium level of it. A distribution of dyspnea perception score at a 20% decrease in FEV₁ relative to baseline (PS₂₀), a perception score of dyspnea at 20% fall in FEV1 of 2 scales represented similar wide, biphasic feature. Statistical relevance was verified with spearman correlation (R(s)=0.903, P<0.001) and Bland-Altman analysis. PS₂₀ of both scores and FeNO had no statistical relationship. While relationship between PS20 by mBorg score and the concentration of methacholine at 20% fall in FEV₁ (PC₂₀) was not significant (R(s)=0.224, P=0.154), that between PS₂₀ by PDS and PC₂₀ was weak positive (R(s)=0.29, P=0.063). CONCLUSION: PDS had similar pattern to assess the dyspnea with the mBorg scale suggesting adequacy of PDS in evaluating pediatric clinical asthma. We expect these scales to help clinical practice in complementary ways.

Inflammation characteristics of nonallergic rhinitis with eosinophilia syndrome / 医学研究生学报

Objective Nonallergic rhinitis with eosinophilia syndrome (NARES) is associated with such diseases as bronchial asthma , nasal polyps , and aspirin intolerance , but there is a lack of studies on its inflammatory conditions .The aim of this study is to describe the inflammation characteristics of NARES . Methods This study included 101 cases of allergic rhinitis ( AR) , 39 cases of NARES, and 162 adult controls .We analyzed the inflammation char-acteristics of the patients using skin prick test ( SPT) , nasal douche , fractional exhaled nitric oxide ( FeNO ) measurement , serum eosino-phil (EOS) counting, serum total IgE (tIgE) determination, induced sputum detection, and nasal and bronchial provocation tests . Results Compared with the controls , the NARES and AR groups showed significant increases in the positive rate of nasal provocation (32.1%vs 69.2%and 75.2%, P<0.05), positive rate of bronchial provocation (1.2%vs 10.3%and 14.9%, P<0.05), and FeNO level ([15.70 ±5.20] ppb vs [37.25 ±22.95] and [39.00 ±24.29] ppb, P<0.05), as well as in the serum EOS and tIgE levels, EOS count, and ratio of EOS in the induced sputum (P<0.05).However, the level of serum tIgE was significantly lower in the NARES than in the AR group (53.3 [23.3-186.0] kU/L vs 197.0 [62.6-391.0] kU/L, P<0.05). Conclusion NARES is a syndrome with nasal, lower airway, and systematic inflammation, similar to AR in inflammatory intensity.Therefore, for patients with NARES, attention should be paid not only to upper airway but also to lower airway and systemic inflammation .

The Lung Function Impairment in Non-Atopic Patients With Chronic Rhinosinusitis and Its Correlation Analysis

OBJECTIVES: Chronic rhinosinusitis (CRS) is common disease in otorhinolaryngology and will lead to lower airway abnormality. However, the only lung function in CRS patients and associated factors have not been much studied. METHODS: One hundred patients with CRS with nasal polyps (CRSwNP group), 40 patients with CRS without nasal polyps (CRSsNP group), and 100 patients without CRS were enrolled. The difference in lung function was compared. Meanwhile, CRSwNP and CRSsNP group were required to undergo a bronchial provocation or dilation test. Additionally, subjective and objective outcomes were measured by the visual analogue scale (VAS), 20-item Sino-Nasal Outcome Test (SNOT-20), Lund-Mackay score, Lund-Kennedy endoscopic score. The correlation and regression methods were used to analyze the relationship between their lung function and the above parameters. RESULTS: The forced expiratory volume in 1 second (FEV1) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) of CRSwNP group were significantly lower than other groups (P<0.05). On peak expiratory flow, there was no difference between three groups. In CRSwNP group, FEV1 was negatively correlated with peripheral blood eosinophil count (PBEC) and duration of disease (r=–0.348, P=0.013 and r=–0.344, P=0.014, respectively), FEF25-75 negatively with VAS, SNOT-20 (r=–0.490, P=0.028 and r=–0.478, P=0.033, respectively) in CRSsNP group. The incidence of positive bronchial provocation and dilation test was lower in CRSwNP group (10% and 0%, respectively), with both 0% in CRSsNP group. The multiple linear regression analysis indicated that change ratio of FEV1 before and after bronchial provocation or dilation test were correlated with PBEC in CRSwNP group (β=0.403, P=0.006). CONCLUSION: CRS leading to impaired maximum ventilation and small airway is associated with the existence of nasal polyp. Lung function impairments can be reflected by PBEC, duration, VAS, and SNOT-20. In CRSwNP patients, PBEC is independent predictor of FEV₁ change ratio.

Value of exhaled nitric oxide in remission stage of asthmatic children / 重庆医学

Objective To explore the value of exhaled nitric oxide evaluate the condition of children with asthma in clinical remission stage .Methods A total of 214 asthmatic children were divided into treatment group and control group .Tests of bronchial provocation and FeNO were performed at the same time .Results FeNO in treatment group was significantly lower than in control group ,while the level of PC20 FEV1 did not have obvious difference in two groups .The level of PC20 FEV1 was negatively correlated with FeNO ,regression equation was Y=35 .883-1 .074X(X= PC20 FEV1 ,Y= FeNO) .Conclusion FeNO is a reliable indicator to evaluate the control situation of non‐specific inflammation in asthmatic children .Combined with bronchial provocation test ,the diag‐nosis rate of asthma in clinical remission stage will significantly raised .

Clinical value of fractional exhaled nitric oxide level in predicting bronchial hyperreactivity in asthmatic children / 国际儿科学杂志

Objective To evaluate the clinical value of fractional exhaled nitric oxide (FeNO) level in asthmatic children to predict bronchial hyperresponsiveness by analyzing the correlation between fraction of exhaled nitric oxide and bronchial provocation test.Methods One hundred and fourteen asthma outpatients of Shengjing Hospital were enrolled, FeNO levels, spirometry and bronchial provocation test were measured.Results In the bronchial provocation test,there were 33 positive and 81 negative cases.The positive group had a significantly higher FeNO levels than the negative ones(19.0 × 10-9 vs.16.0 × 10-9 ,p =0.000).By the ROC curve, the best FeNO cut-off value to predict bronchial hyperresponsiveness was 38.5 × 10-9 with high specificity (92.6％) but relatively low sensitivity (36.4％).There was no relationship between methacholine provocative dose causing a 20％ fall in FEV1 (PD20-FEV1) and the level of FeNO.Conclusion FeNO level has important predicting value for bronchial hyperreactivity in children with asthma.The level of FeNO ＞ 38.5 × 10-9 has high predictive value in asthmatic children with bronchial hyperreactivity.

The relationship of bronchial provocation tests and the onset of the disease / 中国综合临床

Objective To investigate the correlation between bronchial provocation tests and the onset of the disease.Methods One hundred and seven patients who hospitalized in General Hospital of China Aviation from 2013-2014 were selected as our subjects.They all were with unexplained symptoms such as cough and asthma suppress.All the patients were performed bronchial provocation tests.In accordance with the onset time,patients were divided into acute (＜ 3 weeks),subacute (3-8 weeks) and chronic (＞ 8 weeks) groups.The positive rates of bronchial provocation test of three groups were compared.Results Of all 107 patients,36 patients were positive and 71 were negative in terms of bronchial provocation test.The cases with acute,subacute and chronic disease history were 16,36 and 55 respectively.The positive rate of bronchial provocation tests in different onset were 56.3％ (9/16),36.1％ (13/36),23.6％ (13/55) respectively,and there was statistics significant difference(x2 =6.275,P ＜ 0.05).The positive rate of bronchial provocation tests in acute group was higher than that in chronic group (x2 =6.165,P ＜ 0.05).There was positive correlation between the positive rate of bronchial provocation tests and the onset,and the correlation coefficient Pearson was 0.239 (P ＜0.05).Conclusion There is a correlation between the positive rate of bronchial provocation tests and the onset.We should strengthen the monitoring in patients with acute onset and follow-up.

Respostas fisiológicas em adolescentes obesos submetidos à broncoprovocação com solução salina hipertônica / Physiological responses in obese adolescents submitted to bronchial provocation with hypertonic saline

INTRODUÇÃO: A hiper-responsividade brônquica é a resposta do aumento dos mecanismos fisiológicos protetores das vias aéreas em indivíduos atópicos e não atópicos. Além disso, a magnitude da hiperresponsividade aérea apresenta influência conforme o grau de obesidade. OBJETIVO: Avaliar as respostas fisiológicas em adolescentes obesos submetidos a hiper-responsividade brônquica a solução salina hipertônica. MATERIAIS E MÉTODOS: Estudo descritivo, transversal e correlacional composto por 15 adolescentes obesos, de ambos os gêneros. O diagnóstico de asma foi realizado por meio de histórico clínico e questionário ISAAC, e a obesidade pelo IMC acima do percentil 95. Utilizou-se o teste de broncoprovocação por solução salina hipertônica para avaliação da hiper-responsividade brônquica, considerando positiva uma diminuição do volume expiratório forçado no primeiro segundo (VEF1) > 15% do valor pré-solução salina e a intensidade da hiper-responsividade brônquica foi calculada pela queda percentual máxima do VEF1 (% Queda máxVEF1). Foram utilizados o teste t independente ou U de Mann-Whitney e a correlação de Spearman rho (p < 0,05). RESULTADOS: Não foram encontradas diferenças significativas entre os asmáticos e não asmáticos para as variáveis antropométricas, espirométricas, lipídicas e hemodinâmicas. Verificaram-se moderadas correlações positivas e diferenças significativas entre o % Queda máxVEF1 com o IMC (p = 0,040) e IMC escore-Z (p = 0,028). Foram detectadas correlações negativas e diferenças significativas para a Queda máxVEF1 e leucócitos (p = 0,005) e para o % Queda máxVEF1 com o sulfato de dehidropiandrosterona (p = 0,032). CONCLUSÃO: Pode-se concluir que os adolescentes obesos submetidos a hiper-responsividade brônquica apresentam alterações espirométricas que estão associadas às inflamações sistêmicas da obesidade.

INTRODUCTION: The bronchial hyperresponsiveness is the response of increased physiological protective mechanisms in the airways of atopic and non-atopic individuals. Furthermore, the magnitude of hyperresponsiveness influences provider submits with the degree of obesity. OBJECTIVE: To evaluate the physiological responses in obese adolescents undergoing bronchial hyperresponsiveness to hypertonic saline. MATERIALS AND METHODS: Cross-sectional and correlation study consisted of 15 obese adolescents of both genders. The diagnosis of asthma was made by clinical history and ISAAC, and obesity as BMI above 95th percentile. We used the bronchial provocation test by hypertonic saline for the assessment of bronchial hyperresponsiveness, considering positive a decrease in forced expiratory volume in one second (FEV1) > 15% of pre-saline and the intensity of bronchial hyperresponsiveness was calculated as the percentage fall maximum of FEV1 (% Fall máxFEV1). We used the independent T or Mann-Whitney U test and Spearman's rho correlation (p < 0.05). RESULTS: There were no significant differences between asthmatics and non-asthmatics for anthropometric, spirometric, lipid and hemodynamic variables. There were positive correlations and significant differences between the % Fall máxFEV1 with BMI (p = 0.040) and BMI Z-score (p = 0.028). There were detected negative correlations with significant differences for Fall máxFEV1 and leukocytes (p = 0.005) and the % Fall máxFEV1 with dehydropiandrosterone sulfate (p = 0.032). CONCLUSION: It can be concluded that obese adolescents have bronchial hyperresponsiveness presented spirometric changes that are associated with systemic inflammation of obesity.

Analysis of bronchial dilation test and bronchial provocation test for 650 cases of asthma patients / 重庆医学

Objective To analyse the airway reversibility and variability for bronchial asthmatic patients .Methods The status of test positive ratio and combined airflow limitation were analysis for 650 Clinical diagnosed asthmatic patients .527 cases were given bronchial dilation test and 123 cases were given provocative test .Results Positive ratio of 527 cases bronchial dilation test was 41 . 4% .Positive ratio of 123 cases provocative test was 52 .0% .The airflow limitation(FEV1/FVC% <70% ) ratio of total 650 cases was 34 .0% .In the 193 cases of combined airflow limitation patients which was given bronchial dilation test ,the positive ratio of bronchial dilation test was 61 .7% .Conclusion Bronchial dilation test need repeat because of its less sensitivity .The positive ratio of provocative test is not high ,so the patients of provocative test negative couldn′t exclude the diagnosis of asthma .The ratio of bronchial dilation test was high for combined airflow limitation asthmatic patients .Its may clew that the patients combined airflow limitation may be exacerbation and need actively therapy .

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

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 PC20 > 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.

Bronchial provocation tests in clinical practice / Teste de broncoprovocação na prática clínica

Bronchial hyperresponsiveness, which consists of an exaggerated response of the airways to bronchoconstrictor stimuli, is one of the main characteristics of asthma, presented in nearly all asthmatic patients. Bronchial hyperresponsiveness may also be present in other diseases, such as allergic rhinitis, chronic obstructive pulmonary disease, cystic fibrosis, heart failure and respiratory infection, and with some medications, such as β-blockers. Bronchial provocation tests (also known as bronchial challenges) are used to evaluate bronchial responsiveness. These tests have become increasingly used over the last 20 years, with the development and validation of accurate, safe and reproducible tests, and with the publication of well-detailed protocols. Several stimuli can be used in a bronchial challenge, and they are classified as direct and indirect stimuli. There are many indications for a bronchial challenge. In this review, we discuss the main differences between direct and indirect stimuli, and the use of bronchial challenges in clinical practice, especially for confirming diagnoses of asthma, exercise-induced bronchoconstriction and cough-variant asthma, and for use among elite-level athletes.

Hiperresponsividade brônquica, caracterizada por uma resposta exagerada das vias aéreas a um estímulo broncoconstritor, é uma das principais características da asma, presente em praticamente todos pacientes asmáticos. A hiperresponsividade brônquica pode estar presente também em outras doenças, como rinite alérgica, doença pulmonar obstrutiva crônica, fibrose cística, insuficiência cardíaca, infecção respiratória e com o uso de algumas medicações, como β-bloqueadores. Os testes de broncoprovocação são utilizados para determinação da responsividade brônquica, e têm sido cada vez mais utilizados nos últimos 20 anos com o desenvolvimento e validação de testes acurados, seguros e reprodutíveis e com a publicação de protocolos bem detalhados. Diversos estímulos podem ser utilizados em um teste de broncoprovocação, sendo classificados em estímulos diretos e indiretos. Existem inúmeras indicações para um teste de broncoprovocação. Nesta revisão, nós discutimos as principais diferenças dos estímulos diretos e indiretos e o uso desses testes na prática clínica, especialmente para a confirmação de asma, broncoconstrição induzida por exercício, tosse variante de asma e em atletas de elite.

Implement bronchial provocative tests in children with asthma remission / 国际儿科学杂志

Bronchial asthma is one of the most common children health problems, with still increasing prevalence.Bronchial hyperresponsiveness is a characteristic feature of asthma,and its measurement may provide a useful adjunct in the diagnosis of asthma. Many children with asthma go into long-term clinical remission at adolescence, but bronchial hyperresponsiveness persists in approximately one half of these subjects, so implement the bronchial provocative tests in children with asthma remission may appears very important.