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.

Actualización en la prueba de provocación bronquial con metacolina en el niño / Update in the bronchial challenge test with methacholine in children

This document updates the recommendations of the bronchial challenge test with methacholine in children. It is based primarily on the recommendations contained in the guide on the technical standard of the bronchial challenge test for methacholine from the European Society of Respiratory Diseases. The main change is the recommendation to use PD20 (methacholine dose that causes a 20% drop in FEV1) instead of PC20 (methacholine concentration that causes a 20% drop in FEV1), which allows for comparable results when different devices and different protocols are used.

Este documento actualiza las recomendaciones de la prueba de provocación bronquial con metacolina en niños. Se basa fundamentalmente en las recomendaciones contenidas en la guía sobre el estándar técnico de la prueba de provocación bronquial de metacolina de la Sociedad Europea de Enfermedades Respiratorias. El principal cambio es la recomendación de utilizar la PD20 (dosis de metacolina que provoca una caída de 20% del VEF1) en vez de PC20 (concentración de metacolina que provoca una caída del 20% en el VEF1), lo cual permite tener resultados comparables cuando se usan diferentes dispositivos y diferentes protocolos.

Association of nasal inflammation and lower airway responsiveness in schoolchildren based on an epidemiological survey

BACKGROUND/AIMS: We sought to increase our understanding of the rhinitis-asthma relationship and improve strategies for the treatment of patients with these diseases. The aim of this study was to identify a connection between upper airway inflammation and lower airway responsiveness. METHODS: We counted eosinophils on nasal smears, and performed spirometry, allergic skin tests, and methacholine challenge tests in 308 schoolchildren plus a questionnaire on respiratory symptoms. The methacholine concentration causing a 20% fall in forced expiratory volume in 1 second (PC20 0.05). No difference in BHR was detected when comparing subjects with and without nasal eosinophils. There were significant differences in the PC20 between subjects with greater than 50% nasal eosinophils and without nasal eosinophils (11.01 +/- 2.92 mg/mL vs. 17.38 +/- 0.61 mg/mL; p < 0.001). CONCLUSIONS: These findings demonstrated that nasal eosinophilic inflammation might contribute to lower airway responsiveness in schoolchildren, based on an epidemiological survey.

Airways are More Reactive to Histamine than to Methacholine in Patients with Mild Airway Hyperresponsiveness, Regardless of Atopy

BACKGROUND: The airway muscles from allergen-sensitized animals in vitro show a heightened response to histamine, but not to carbachol. This study investigated whether the airway responsiveness to histamine in vivo is comparable to that of methacholine in human subjects with varying degrees of atopy. METHODS: One-hundred-and-sixty-eight consecutive adult asthma patients or volunteers underwent bronchoprovocation tests to both histamine and methacholine after determining their blood eosinophil counts, serum total IgE levels and skin test reactivity to 10 common aeroallergens. RESULTS: The responsiveness to histamine was significantly related to that to methacholine (r=0.609, p<0.001), but many individuals with a negative methacholine test response showed a positive response to histamine. The histamine-bronchial reactivity index (BRindex) was significantly higher than the methacholine-BRindex in subjects with a positive response to none (n=69, p<0.01) or only one (n=42, p<0.001) of histamine and methacholine, while there was no significant difference in the subjects with positive responses to both of them (n=57). The histamine-BRindex was significantly higher than the methacholine-BRindex in the subjects with mild histamine hyperresponsiveness (n=58, 1.28+/-0.01 vs. 1.20+/-0.02, respectively, p<0.001). Both histamine and methacholine responsiveness was significantly related to the atopy markers. However, the histamine-BRindex/methacholine-BRindex ratio of the atopics was not significantly different from that of the non-atopics. CONCLUSIONS: The airway responsiveness to histamine is comparable to that of methacholine in the subjects with positive responses to both histamine and methacholine, but the airway responsiveness to histamine is greater than that to methacholine in those subjects with mild airway hyperresponsiveness, regardless of atopy.

Avaliação da hiperresponsividade brônquica à solução salina hipertônica em crianças e adolescentes / Bronchial hyperresponsiveness to hypertonic saline challenge in children and adolescents

OBJETIVO: Avaliar a hiperresponsividade brônquica à solução salina hipertônica a 4,5 por cento como método alternativo a outros agentes broncoconstritores e sua relação com a sensibilização alérgica do paciente. MÉTODOS: Estudo transversal, experimental, com 85 indivíduos assim distribuídos: 45 no grupo de asmáticos e 17 no grupo controle não asmáticos e não alérgicos, que completaram o teste. Para nebulizar a solução salina hipertônica foi utilizado um nebulizador ultra-sônico de grande volume, sucessivamente durante 0,5, 1, 2, 4 e 8 minutos até haver queda > 15 por cento em relação ao volume expiratório forçado no primeiro segundo basal. A dosagem de imunoglobulina E específica ao Dermatophagoides pteronyssinus por ImmunoCap foi considerada positiva quando > 0,35 kU/L. RESULTADOS: No grupo de asmáticos, 36 apresentaram queda média do volume expiratório forçado no primeiro segundo de 27,4 por cento após nebulização de solução salina hipertônica. Nenhum do grupo controle (imunoglobulina E < 0,35 kU/L) apresentou resposta à solução salina hipertônica e a queda média do volume expiratório forçado no primeiro segundo foi de 9 por cento. Nove asmáticos tiveram provocação brônquica negativa. A freqüência de provocação brônquica positiva foi maior nos indivíduos com imunoglobulina E específica elevada, o que indica uma relação entre hiperresponsividade brônquica e o nível sérico de imunoglobulina E específica. A sensibilidade do teste foi de 80 por cento e a especificidade de 92 por cento. CONCLUSÃO: A inalação de solução salina hipertônica é um método de provocação útil para avaliar hiperresponsividade brônquica em crianças e adolescentes, com adequadas sensibilidade e especificidade, além do baixo custo e necessidade de poucos equipamentos.

OBJECTIVE: To assess airway hyperresponsiveness to 4.5 percent hypertonic saline solution in comparison to that obtained through challenge with other bronchoconstriction agents and in relation to patient allergic sensitization. METHODS: A cross-sectional, experimental study was conducted, initially involving 85 subjects. After exclusions, the final sample consisted of 62 patients, divided into two groups: a study group of those with asthma (n = 45) and a control group of those with no asthma or allergies (n = 17). Hypertonic saline was nebulized using an ultrasonic nebulizer and administered successively for 0.5, 1, 2, 4 and 8 minutes until a drop in forced expiratory volume in one second of = 15 percent was achieved in relation to the baseline value. The level of specific immunoglobulin E to Dermatophagoides pteronyssinus level was determined by ImmunoCAP assay and was considered positive when > 0.35 kU/L. RESULTS: In the 36 asthma group subjects presenting a response, the mean drop in forced expiratory volume in one second after hypertonic saline nebulization was 27.4 percent. None of control group subjects (immunoglobulin E < 0.35 kU/L) presented a positive response to hypertonic saline. The mean forced expiratory volume in one second for control group subjects was 9 percent. The results of a bronchial provocation test were negative in 9 of the asthma group subjects. The frequency of bronchial provocation test positivity was higher in the subjects presenting elevated levels of specific immunoglobulin E, indicating that there is a relationship between bronchial hyperresponsiveness and the level of specific immunoglobulin E. The sensitivity and specificity of the test were 80 percent and 92 percent, respectively. CONCLUSION: Bronchial provocation with hypertonic saline presents satisfactory sensitivity and specificity. Therefore, in addition to being a low cost procedure that requires very little equipment, it is a useful means of assessing ...

Airway Hyperresponsiveness to Hypertonic Saline as a Predictive Index of Exercise-Induced Bronchoconstriction

BACKGROUND: Changes in airway mucosal osmolarity are an underlying mechanism of bronchoconstrictive responses to exercise and hypertonic saline (HS). The purpose of this study was to examine whether an osmotic challenge test using HS can predict exercise-induced bronchospasm (EIB) in asthma patients. METHODS: Thirty-six young male asthmatic patients underwent bronchial challenge tests based on 4.5% HS, exercise (> 24h later), and methacholine (MCh) at the Chonnam National University Hospital. The relationships between responses to HS and exercise, and between MCh and exercise were evaluated. RESULTS: The maximal fall in forced expiratory volume in one second following exercise was significantly higher in the HS-responders (n=19) than in the HS-nonresponders (n=17, 35.9+/-4.1% vs. 17.9+/-2.7%, p< 0.001), and there was a significant correlation between the severity of EIB and HS-airway hyperresponsiveness (AHR). When compared with the MCh-AHR test in terms of predicting EIB, the HS-AHR test showed higher specificity (71.4% vs. 42.9%), but a lower sensitivity (58.6% vs. 89.7%) and negative predictive value (29.4% vs. 50.0%). At the moderate AHR cutoff value, the MCh-AHR test had a specificity that was comparable with and predictive values that were higher than those of the HS-AHR test. CONCLUSIONS: The HS-AHR test was more specific than the MCh-AHR test, but was less sensitive and had a poorer negative predictive value, which in combination preclude the use of the HS-AHR test as a screening tool for EIB. The MCh-AHR test had a cutoff value for moderate AHR that may be more useful for predicting EIB in asthmatic patients.

Airway Inflammation and Allergen Specific IgE Production May Persist Longer Than Airway Hyperresponsiveness in Mice

During the preclinical study of new therapeutic modality, we evaluate whether the treatment can reverse the established asthma phenotypes in animal model. However, few have reported on the long term persistence of asthma phenotypes upon re-challenge with allergen (secondary challenge) in animal model. We evaluated the persistence of asthma phenotypes by secondary challenge at different times in previously challenged murine asthma model. BALB/c mice sensitized by intraperitoneal injections of 20 microgram of ovalbumin and 1 mg of alum on days 1 and 14 were challenged initially by the inhalation of 1% ovalbumin for 30 min on days 21, 22, and 23. Each group of mice was rechallenged at 5, 7, 9, or 12 weeks after the initial challenge. Airway hyperresponsiveness, BAL fluid, airway histology and serum ovalbumin-specific IgE level were evaluated. Airway eosinophilia, airway inflammation and serum ovalbumin-specific IgE production persisted upon secondary allergen challenges at least 12 weeks after the initial challenge. However, airway hyperresponsiveness persisted only until mice were rechallenged 7 weeks after the initial challenge. Airway inflammation and allergen specific IgE production may persist longer than airway hyperresponsiveness in a mouse asthma model of secondary allergen challenge.

The Validity of the ISAAC Written Questionnaire and the ISAAC Video Questionnaire (AVQ 3.0)for Predicting Asthma Associated with Bronchial Hyperreactivity in a Group of 13-14 Year Old Korean Schoolchildren

To validate the prevalence rate of symptoms of asthma produced by the phase I ISAAC (International Study of Asthma and Allergies in Childhood) study, hypertonic saline challenge test was carried out during the phase II study at a year after the phase I study. For the phase II study, six middle schools from three cities in the phase I study were selected. Finally, 499 children who responded to both studies were analyzed. All subjects were asked to complete the written questionnaire (WQ) first, followed by a video questionnaire (AVQ 3.0) during the phase I study. Of the 499 children, only 19 (3.8%) were positive to the hypertonic saline bronchial challenge test. The degree of agreement between responses to the two corresponding questions "wheezing at rest" and "nocturnal wheeze" in the AVQ 3.0 and WQ were moderate and weak with a Kappa indices of 0.45 and 0.23, respectively. The question on "severe wheeze" in the AVQ 3.0 had the highest Youden's index among the five questions related to asthma symptoms in the previous 12 months, but its specificity was low whereas it 's sensitivity was 1.0. There was no consistency of priority between the two questionnaires in predicting bronchial hyperreactivity in a group of Korean schoolchildren. Therefore we need to develop more appropriate WQ or AVQ to compare the prevalences of asthma to other countries.

Cough and asthma.

Cough is a common symptom in office practice. Though troublesome, it serves to maintain normal function of respiratory tract. Chronic or recurrent cough may be caused by variety of diseases, asthma being the most common amongst them. Cough, wheeze and breathlessness are classical features of asthma syndrome. Many diseases may lead to this syndrome. Asthmatic children present with cough of variable intensities and patterns. At times, wheeze and breathlessness may not be clinically apparent. It was well known that all that wheezes is not asthma but now it is well understood that every asthmatic child does not wheeze. In an acute attack of asthma, cough often starts at the end of wheezing episode. It leads to expulsion of thick, stringy mucus often in the form of casts. Though cough is a minor symptom during acute attack, it ensures removal of secretions and avoid complications. Cough is a prominent symptom in persistent asthma especially between acute exacerbations. Episodic nocturnal cough may be the only symptom of chronic asthma. Children with cough variant asthma do not wheeze. It is postulated that they have milder degree of airway hyperresponsiveness and higher wheezing threshold. However, they show all the characteristics of asthma on laboratory tests. Cough represents bronchial hyperresponsiveness and is not a measure of asthma. Hence it may be caused by many diverse etiologies such as gastroesophageal reflux, enlarged adenoids, sinusitis or tropical eosinophilia. Cough in such conditions mimicks asthma and relevant tests may be necessary for proper diagnosis.

Procedimiento para realizar pruebas broncodinámicas con alergenos inhalados / Proccedings to bronchodynamics tests with inhalated allergens

El asma es una de las enfermedades crónicas más frecuentes de los niños. Se caracteriza por hiperreactividad de las vías aéreas a estímulos inespecíficos (metacolina e histamina) y específicos (alergenos). Las pruebas broncodinámicas determinan la broncolabilidad del niño asmático y ayudan a establecer el diagnóstico funcional. Deben realizarse con extractos antigénicos de alta calidad, acuosos liofilizados y estandarizados; se puede utilizar un circuito abierto o cerrado y un dosímetro, la dosis inicial del alergeno es más baja que con la que se obtuvo la reactividad cutánea positiva, realizando incrementos sucesivos hasta que el VEF-1 descienda 15 por ciento o más. La seguridad del paciente es fundamental, por eso las pruebas debe realizarlas personal especialmente adiestrado.

Long-term stability of bronchial reactivity in guinea pigs.

Measurement of lung function and bronchial reactivity are widely used as outcome parameters to assess the efficacy of therapeutic interventions. In order to interpret the results correctly, it is necessary that the outcome parameters are themselves stable over time so that any significant changes measured may be attributed to the interventions. Specific airway conductance (SGaw) and airway reactivity to histamine are two commonly used parameters in animal models such as guinea pigs. Although short-term variability of these parameters has been investigated, there has been no study of long-term stability. In the present paper, SGaw and bronchial reactivity to histamine were measured in 111 conscious guinea pigs using a non-invasive, whole body plethysmograph. Baseline values of SGaw and ED35 histamine were measured and followed for eight weeks at weekly intervals. At baseline, mean SGaw in guinea pigs was 0.17 +/- 0.055 sec-1 cm H2O-1 and ED35 histamine ranged from 0.064 to more than 10 mg/ml. The distribution of ED35 histamine values was gaussian. We observed that the changes in SGaw and ED35 histamine recorded using this technique are highly reproducible over eight weeks. The reactivity varied by less than a doubling dose of histamine over any two consecutive weeks. Thus, the technique described in this paper is quick, easily learned, reproducible, independent of temperature-humidity artifact and highly suitable for studies of repeated measurements as in the study of dietary interventions and evaluation of effect of drugs.

Asma Brônquica: Correlaçäo de achados em tomografia computadorizada de alta resoluçäo com dados clínicos / Bronchial asthma: correlation of high resolution computed tomography findngs with clinical data

Resumo: Neste trabalho foi realizado estudo seccional de 31 pacientes asmáticos em diversos graus de sereveridade da doença, que foram submetidos a tomografia computadorizada de alta resoluçäo do tórax e espirometria, entre os meses de julho de 1995 e agosto de 1997. Os achados tomográficos foram correlacionados com a classificaçäo clínica dos pacientes e os mais frequentes foram o espessamento da parede brônquica, dilataçäo brônquica, aprisionamento aéreo, opacidade centrolobulares, densidades lineares cicatriciais, impactaçäo mucóide, enfisema e atelectasia. Em asmáticos de longa data, obeservamos predominância do acometimento de pequenas lesöes irreversíveis. Nos pacientes tabagistas näo houve frequencia aumentada de enfisema.

Hiperreactividad en 30 niños sin asma con dermatitis atópica / Bronchial hyperreactivity in children with atopic dermatitis

Introducción. La importancia de la dermatitis atópica (DA) no sólo radica en su alta morbilidad, con topografía y morfología dérmica características, sino que además existen manifestaciones extracutáneas, de las cuales la hiperreactividad bronquial (HRB) puede estar presente expresándose posteriomente como asma bronquial, por este motivo el objetivo del trabajo fue determinar la presencia de HRB en 30 niños con DA sin diagnóstico de asma o afección pulmonar previa. Material y métodos. Se realizó un estudio prospectivo, transversal, en 30 niños de 6 a 16 años de edad que acudieron al Hospital Infantil de México Federico Gómez con diagnóstico de DA. Para determinar la presencia de HRB se realizaron pruebas de función pulmonar (espirometría basal y posterior al reto con diferentes concentraciones de metacolina). El análisis estadístico se llevó a cabo por la prueba t de Student pareada con corrección de Kurtosis. Resultados. La edad media fue de 11 años, con una relación femenino/masculino de 1.5: 1. De los 30 pacientes, 21 tuvieron reto positivo, demostrado por el descenso del VEF1 con respecto a la basal de 20 por ciento acompañándose de tos, opresión torácica y sibilancias. Al analizar los valores del VEF1 se encontró significancia estadística (P=0.0125) de los basales comparados con cada reto. De esta manera se observa que 70 por ciento tuvo HRB, concordando con lo reportado por otros autores, en los cuales más de la mitad de los pecientes con DA presentan HRB. Conclusión. Es necesario vigilar estrechamente a los pacientes con DA ya que como se demostró en este estudio, existe la posibilidad de que en algún momento de la vida pudieran presentar asma bronquial y aunque no se pueda evitar en su totalidad sí se podrían tomar las medidas necesarias para disminuir esta posibilidad basados en la pevención

Pruebas respiratorias para el diagnóstico de enfermedad pulmonar obstructiva e hiperreactividad bronquial / Respiratory tests for the diagnosis of obstructive lung disease and lung hyperreactivity

Se realizó un estudio modelado de detección precoz de la enfermedad pulmonar obstructiva con espirometria forzada en 50 individuos fumadores que acudieron al Examen Médico de Control de Salud en el ISMM "Dr. Luis Díaz Soto"; en 60 fumadores trabajadores de la fábrica de cigarrillos José Martí en Centro Habana, y en 100 hipertensos que acudieron a consulta multidisciplinaria especializada de nuestro Instituto. Las pruebas funcionales respiratorias resultaron patológicas en la mayoría de los grupos estudiados, en relación con el tabaquismo. Se hizo además, un estudio de provocación bronquial con nebulización de agua destilada en 47 individuos con antecedentes de síndrome bronquiales recurrentes, en el que se observó una tendencia a la disminución de los valores espirográficos tras la nebulización. Se observó la utilidad de la espirografía forzada en el diagnóstico de la neumopatía obstructiva y en la detección de la hiperreactividad bronquial, así como la utilidad de la nebulización de agua destilada para dicho fin

Un índice del tamaño pulmonar mejora la predicción de valores de referencia de PC20 metacolina en un grupo de niños y adultos normales chilenos / A index of lung volume improves the prediction of reference values of methacholine PC20 in normal chilean children and adults

Con el propósito de examinar la validez del límite inferior de lo normal de 8 mg/ml para la PC20 metacolina en individuos normales chilenos, estudiamos 79 sujetos, 39 hombres y 40 mujeres, con edades entre 6 y 75 años. Se excluyeron los sujetos con condiciones capaces de alterar la respuesta a metacolina. En todos se efectuó una espirometría y una prueba de provocación con metacolina hasta llegar a concentraciones de 256 mg/ml, obtener un plateau o una caída del VEF, de 40 por ciento o más respecto del valor basal La PC20 se calculó por interpelación. También se efectuó un prick test con 9 alergenos comunes, clasificando como atópicos a aquellos que reaccionaron con uno o más alergenos. Se obtuvo PC20 en 35 individuos (44 por ciento), 11 de los cuales (13,9 por ciento) presentaron PC20 por debajo de 8 mg/ml. Hubo mayor prevalencia de PC20 en mujeres que en hombres (51,1 por ciento vs 31,6 por ciento, p < 0,05). No hubo diferencias de PC20 entre atópicos y no atópicos. Los individuos en los que se obtuvo PC20 fueron signifícativamente menores (25,6 ñ 18,8 vs 41,4 ñ 18,6 años, p < 0,01) y tuvieron menores valores absolutos de CVF (3.232 ñ 1.017 vs 4.038 ñ 1.245 ml, p <.0,025) y VEF, (2.793 ñ 920 vs 3.405 ñ 1.073 ml, p < 0,05). El log PC20 se correlacionó significativamente con CVF, VEF, y talla. En una correlación múltiple paso a paso sólo CVF entró al modelo de predicción de PC20. Los niños más pequeños e individuos mayores, con menores CVF, tuvieron PC20 más bajas. Concluimos que el límite inferior de lo normal de 8 mg/ml es inadecuado para los individuos con CVF pequeña, independientemente de la edad, por lo que una predicción de PC20 que considere este factor mejorará la sensibilidad y la especificidad en el diagnóstico de hiperreactividad bronquial

Tensión trascutánea de oxígeno y sibilancias en la evaluación de la reactividad bronquial en niños sanos y asmáticos de 3 a 6 años / Transcutaneous oxygen tension and wheezing during methacholine challenge test in normal and asthmatic 3 to 6 years old children

La tensión transcutánea de oxígeno (tcPO,) se correlaciona con el VEF, durante la prueba de provocación con metacolina (MC). Nuestro objetivo fue evaluar la reactivídad bronquial en niños de 3 a 6 años utilizando la medición de la tcPO2 y presencia de sibilancías durante la prueba de MC. Se estudiaron 28 niños sanos (S), 13 hombres, edad 4,6 ñ 1 años (promedio ñ DS) y 32 asmáticos (A), (18 hombres) 4,6 ñ 1 años. Los niños sanos no presentaron antecedentes familiares de asma ni infección respiratoria 4 semanas antes del examen. Los asmáticos se clasificaron como leves (11), moderados (17) y severos (4). La prueba de MC se realizó duplicando la dosis desde 0,06 a 8 mg/ml según Cockroft y cols (Clín Allergy 1977;7:235). Se monitorizó a) tcPO2 con un electrodo a 44ºC en el antebrazo, b) SaO2, c) sibílancias, d) frecuencia respiratoria. La caída de un 20 por ciento de la tcPO2 desde su valor basal (PC20-tcPO2), o algún efecto adverso fueron los criterios de término de la prueba. La tcPO2 varió en el grupo de sanos desde 88 ñ 13 a 74 ñ 18 mmHg y en asmáticos desde 74 ñ 8 a 55 ñ 6 mmhg desde el valor basal al final respectivamente (p < 0,0l). Las sibílancias estuvieron presentes a 1,5 ñ 1 mg/ml de metacolina en S y a 0,3 ñ 0,3 mg/ml en A (p < 0,0l). La PC20 tcPO, fue de 1,8 ñ 1 mg/ml en S y de 0,4 ñ 0,4 mg/ml en A (p < 0,01). Las sibilancias se correfacionaron con la PC20-tcPO2 (r= 0,67; p< 0,001). La PC20-tcPO2 estuvo presente en 17/28 sanos y en 32/32 asmáticos (p < 0,001; x2). La concentración de MC de 0,75 mg/ml tuvo una sensibilidad de 91 por ciento y especificidad de 93 por ciento para detectar hiperreactividad bronquial El examen se repitió en 10 niños (4 sanos) en un lapso de 3 a 6 meses, obteniéndose valores que estuvieron dentro de un 10 por ciento de variabilidad. Se concluye que la tcPO2 y sibilancias son útiles en la evaluación de la reactívidad bronquial en asmáticos que no colaboran con las pruebas espirométrícas

Avaliaçäo da hiper-reatividade brônquica inespecífica em crianças com idade inferior a 24 meses / Non specific bronchial hyperreactivity in infants

Objetivos: Avaliar a presença de hiper-reatividade brônquica (HRB) em "Bebês chiadores" (BC) e Controles normais (C) utilizando o teste de broncoprovaçäo (TBP) com metacolina (M). Métodos: Cinqüenta e um BC e 20 C, todos menores de 2 anos de idade, acompanhados no Departamento de Pediatria da UNIFESP-EPM, foram submetidos a TBP com M, tendo a ausculta pulmonar como parâmetro de monitoragem para avaliaçäo da CPS (concentraçäo provocadora de sibilo)....