Bronchial provocation tests in clinical practice

Borges, Marcos C.; Ferraz, Erica; Vianna, Elcio Oliveira

doi:10.1590/s1516-31802011000400008

Cited by 9 publications

(10 citation statements)

References 47 publications

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“…Bronchial hyper responsiveness is a characteristic of individuals with asthma, although it is not always present, depending on the treatment given or the type of definition employed [19]. However, bronchial hyper responsiveness can also be found in many other conditions, such as allergic rhinitis, COPD, right after respiratory infections, bronchiectasis, cystic fibrosis, heart failure, acute chest syndrome of sickle cell anemia, use of beta blockers, etc [20][21][22]. All these conditions described can present with wheezing and certainly do not characterize asthma.…”

Section: Discussionmentioning

confidence: 99%

Wheezing in Childhood- not Always Asthma -Review

2019

JCEI

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Wheezing in infancy and childhood is a common condition; however it is not a single disorder and can be due to causes other than asthma. Wheezing is a musical, expiratory sound due to narrowing and hyper responsiveness of the intra-thoracic and extra thoracic airways. Not all wheezing is asthma. Wheezing-associated respiratory illnesses in children are often described as asthma; however while most children with asthma show symptoms of wheezing. Wheezing, coughing and breathlessness are common in young children, and can all be symptoms of conditions other than asthma. Bronchiolitis refers to a first episode of wheezing, with respiratory distress triggered by a viral infection. Episodic wheezing refers to discrete episodes of wheezing without intermittent symptoms. Unremitting wheezing refers to distinct episodes of wheezing with intermittent symptoms, such as coughing or wheezing at night or in response to exercise, crying, laughter, mist, or cold air. Environmental conditions that increase the rate of bacterial and viral infections are risk factors for transient wheezing, but its relationship to asthma remains unclear. Children with frequent simple colds and other common childhood infections in infancy are less likely to develop persistent wheezing in later childhood. Many preschool children with viral induced wheezing will outgrow these symptoms, and do not have asthma. Generally, asthma is identified by the presence of cough, wheeze and breathing difficulty, together with features of atopy (or a family history of atopy or asthma) and impaired lung function evidenced by spirometry. It is important to explain to parents/ carers that wheezing in an infant or preschooler does not mean the child will have asthma or allergies by primary school age. In preschool-aged children with recurrent wheeze (e.g. four or more episodes per year), consider using the Asthma Predictive Index, to estimate whether children are likely to have asthma during primary school years. Asthma Prediction Index has some major criteria and minor criteria. Major criteria are diagnosis of asthma in one or both parent, Diagnosis of atopic dermatitis during the first 3 yr. of life, Sensitization against >1 allergen, Minor criteria- Milk, egg, or peanut sensitization. Associated with respiratory infections, Eosinophilia >4%. In the first 3 years of life if anyone who have 1 major criteria or 2 minor criteria is present in one episode, the possibility of asthma in 6-13 years is 59% but 2 episodes possibility is 77%. Investigation -Chest X-Ray, spirometry, CT scan of Chest and Fiberoptic Bronchoscope. It is usually not necessary if history of “classic” asthma or, patient response to salbutamol and or steroid; then only spirometry should be done. But need other investigation when Chronic cough (>1 month), recurrent pneumonia, persistent signs or symptoms are seen despite therapy. Bronchomalacia, esophageal dilatation, foreign body aspiration, vocal cord dysfunction, viral pneumonia allergic rhinitis, bronchiectasis, cystic fibrosis, heart failure, acute chest syndrome of sickle cell anemia, use of beta blockers, etc. All these conditions described can present with wheezing and certainly do not characterize asthma. Here we reported six case series having wheeze but ultimate diagnosis was not asthma.

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Section: Discussionmentioning

confidence: 99%

Wheezing in Childhood- not Always Asthma -Review

2019

JCEI

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“…5 This test uses bronchoconstriction stimuli, such as methacholine, and it is considered to be the best choice for diagnosing asthma in patients with normal spirometry tests. 5,6 Bronchial challenge corroborates the diagnosis of asthma through confirming the presence of bronchial hyperresponsiveness. More importantly, it may rule out this diagnosis when bronchial hyperresponsiveness is not detected, because its negative predictive value is high.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of spirometry for detection of asthma: a cross-sectional study

Meneghini

Paulino

Pereira³

et al. 2017

Sao Paulo Med. J.

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BACKGROUND: Asthma is a chronic inflammatory disease with airway hyperresponsiveness. Spirometry is the most commonly used test among asthmatic patients. Another functional test used for diagnosing asthma is the bronchial challenge test. The aim of this study was to analyze the accuracy of spirometry for detecting asthma in the general population. DESIGN AND SETTING: Cross-sectional study with data analysis to evaluate the accuracy of spirometry through calculating sensitivity, specificity and predictive values and through the kappa agreement test. METHODS: Subjects who constituted a birth cohort were enrolled at the age of 23 to 25 years. Spirometric abnormality was defined as reduced forced expiratory volume in one second, i.e. lower than 80% of the predicted value. Measurement of bronchial responsiveness was performed by means of the bronchial challenge test with methacholine. The gold-standard diagnosis of asthma was defined as the presence of bronchial hyperresponsiveness in association with respiratory symptoms. RESULTS: Asthma was detected in 200 subjects (10.4%) out of the sample of 1922 individuals. Spirometric abnormality was detected in 208 subjects (10.9%) of the sample. The specificity of spirometric abnormality for detecting asthma was 90%, sensitivity was 23%, positive predictive value was 22%, and negative predictive value was 91%. The kappa test revealed weak agreement of 0.13 (95% confidence interval, CI: 0.07-0.19) between spirometry and the diagnosis of asthma. CONCLUSION: Spirometry, as a single test, has limitations for detecting asthma in the general population.

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“…Bronchial hyperresponsiveness is one of the main pathophysiological characteristics of asthma and is present in nearly all asthmatic patients, especially during symptomatic episodes. It can also be found in other diseases, such as allergic rhinitis, chronic obstructive pulmonary disease, cystic fibrosis and heart failure, or after a respiratory infection (2).…”

Section: Introductionmentioning

confidence: 99%

Cough Reflex Sensitivity Testing in Asthmatic Patients and Healthy Volunteers

Neuschlová¹,

Péčová²

2013

Acta Medica Martiniana

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A b s t r a c t Asthma and allergic diseases are complex conditions caused by a combination of genetic and environmental factors. Cough is a major symptom in some people with asthma. Cough reflex sensitivity (CRS) test with capsaicin is one of the most important method for cough studying. Cough reflex sensitivity was defined as the lowest concentration of capsaicin that elicited 2 or more (C2) and 5 or more coughs (C5). The aim of this study was to find out a cough reflex sensitivity in patients with asthma bronchiale and in healthy volunteers. In the present study we conclude that cough reflex sensitivity was significantly increased in asthmatic adult patients compared with healthy adult volunteers.

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Bronchial provocation tests in clinical practice

Cited by 9 publications

References 47 publications

Wheezing in Childhood- not Always Asthma -Review

Wheezing in Childhood- not Always Asthma -Review

Accuracy of spirometry for detection of asthma: a cross-sectional study

Cough Reflex Sensitivity Testing in Asthmatic Patients and Healthy Volunteers

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