ABSTRACT
Objective To investigate the diagnostic value of Astograph methacholine provocation test in patients with chest tightness variant asthma ( CTVA)??Methods From January 2011 to February 2017,156 patients with CTVA in outpatient or inpatient department of respiratory medicine of Kailuan General Hospital affiliated to North China University of Science and Technology were selected as case group ( chest tightness variant asthma group )??The control group were 361 non?asthmatic patients including interstitial lung disease ( 23 cases), coronary disease ( 157 cases), hypertensive cardiopathy ( 22 cases), myocardiosis (16 cases),congenital heart disease ( 3 cases),rheumatic valvular heart disease (6 cases), central airway disease (3 cases),thyromegaly (10 cases),mediastinal tumor (5 cases),thoracic or spinal deformity (8 cases),phrenoparalysis (2 cases) and vegetative nerve functional disturbance (106 cases)??All participants received pulmonay ventilation test, average daily and nightly variation rate of PEF ( Peak expiratory flow) or PEF weekly variability, Astograph methacholine provocation test ( forced expirataory volume in one second≥70% expectation),and other relevant examinations??The diagnostic value of Astograph methacholine provocation test on CTVA was assessed by analyzing the sensitivity, specificity, positive predictive value,negative predictive value,and Yunden index of Astograph methacholine airway??Results Compared with the control group (( 1??18 ± 0??44)%), theforced expiratory flow from 75% of Forced vital capcacity ( FEF75 ) index of CTVA group (( 1??29 ± 0??50 )%) had significant difference (, t＝ 2??96, P＝0??006)??The sensitivity,specificity,positive predictive value,negative predictive value,Yunden index,and diagnostic accuracy of Astograph methacholine provocation test on CTVA were 0??814,0??695,0??536,0??305, 0??509 and 0??731, respectively??Conclusion The sensitivity, negative predictive value, Yunden index and diagnostic accuracy of Astograph methacholine provocation test on CTVA were higher,whereas the specificity and positive predictive value were relatively lower,suggesting that Astograph methacholine provocation test had a reliable diagnostic value on CTVA,with lower false negative and higher false positive??
ABSTRACT
Objective To analyze the characteristics of airway hyperresponsiveness and fractional exhaled ni-tric oxide (FeNO)in children with chest tightness variant asthma (CTVA)in comparison with cough variant asthma (CVA)and the typical asthma. Methods From January 2012 to June 2015,37 atypical asthma children with chest tightness as the sole presenting manifestation were selected as subjects (CTVA group). Meanwhile,100 children who were newly diagnosed as CVA and 100 children who were newly diagnosed as typical asthma were selected as control group. All of the children in 3 groups had completed FeNO measurement,spirometry and with either positive result of bronchial provocation test or positive result of bronchial dilation test. The differences in FeNO and spirometry data among 3 groups were analyzed. Results FeNO was 11. 0(6. 0,33. 0)ppb in CTVA group,but 28. 0(16. 0,52. 0) ppb in typical asthma group,which indicated that FeNO was significantly lower in CTVA group than that in typical asth-ma group (P < 0. 05). The accumulated provocative dose of methacholine resulted in a 20％ (PD20-FEV 1 )drop in forced expiratory volume in 1 second (FEV 1 ),which was 0. 480(0. 145,0. 663)mg in CTVA group and 0. 180 (0. 097, 0. 463)mg in typical asthma group. PD20-FEV 1 was significantly higher in CTVA group than that in typical asthma group,and the difference was statistically significant(P < 0. 05). FeNO was 18. 5(8. 0,34. 0)ppb and PD20-FEV 1 was 0. 330(0. 120,0. 730)mg in CVA group,which had no statistically significant differences between CTVA group and CVA group(all P > 0. 05). Conclusion CTVA children have lower airway hyperresponsiveness and lower FeNO than typical asthma children. CTVA children may have similar airway hyperresponsiveness as CVA children.
ABSTRACT
The chest tightness variant asthma (CTVA)is a new clinical variant of asthma,with chest tightness or sighing respiration as the main or only clinical manifestations,without wheezing,shortness of breath and other typical symptoms of asthma. And the patients with CTVA are likely to be misdiagnosed in clinical work. The clinical features are chest tightness existed persistently or repeatedly,symptoms lasting more than 8 weeks,the presence of airway hype-rresponsiveness or reversible airflow limitation confirmed by lung function examination,effective to the treatment of β agonists or inhaled corticosteroids,and other diseases should be excluded.