Cardiac arrhythmia monitoring during bronchial provocation test with methacholine.

STUDY OBJECTIVES: During a bronchial provocation test (BPT), the performance of maximal inspiratory-expiratory maneuvers, causing abrupt and marked shifts in intrathoracic pressure, may increase the risk of cardiac arrhythmias. Moreover, the inhalation of methacholine (MCh), a cholinergic agonist agent, could favor the development of unwelcome cardiovascular events, namely, cardiac arrhythmias. SUBJECTS AND METHODS: We studied the number and severity of cardiac arrhythmias by ECG-Holter monitoring before, during, and after BPTs with MCh challenge in a group of 46 consecutive nonselected subjects (28 men and 18 women) with clinical indications for BPT, without preexisting cardiovascular diseases, and not receiving arrhythmogenic drugs. The subjects performed a routine pulmonary function test (PFT), followed by BPT, during ECG-Holter monitoring. Determination of the serum potassium concentration, a baseline arterial blood gas analysis, and monitoring of oxyhemoglobin saturation also were performed. RESULTS: We found no significant increase in the number of supraventricular and ventricular arrhythmias during the performance of PFTs and of BPTs with MCh in the subjects, either with or without bronchial hyperresponsiveness (BHR). However, during the performance of BPTs, we observed a significant reduction in mean heart rate. CONCLUSIONS: Our results indicate that the performance of PFTs and BPTs with MCh does not increase the cardiac arrhythmogenic risk in subjects without cardiovascular diseases, as well as in those with BHR, suggesting that these tests are safe to perform in most subjects.

[General practitioner and respiratory medicine specialist. A survey on the management of the asthmatic patient]. / Indagine conoscitiva sul rapporto tra medico di medicina generale e specialista in medicina respiratoria nella gestione clinica del paziente asmatico.

The relationship between the general practitioner (GP) and the respiratory medicine physician specialist in the management of the asthmatic patients was examined. Two-hundred sixty -two GPs from Brescia and province were enrolled into the study and underwent an appropriate questionnaire, focusing the survey on three aspects: the relationship among GP-respiratory medicine physician specialist and asthma patients, the training of GP, the appraisal of the socio-economic aspects of the management of bronchial asthma. The results have shown the requirement of a GP-respiratory medicine physician specialist relationship founded on the exchange of information and experiences, rather then of synthetic diagnoses and therapeutic directions, and the opportunity to establish outpatients' departments dedicated to the management of the asthmatic patients. Moreover, it has been shown an inadequate application of international guidelines and a not full appraisal of the socio-economic aspects of the management of the asthmatic patients.