Comparing methods for assessing bronchial responsiveness in children: single step cold air challenge, multiple step cold air challenge, and histamine provocation

Modl, Manfred; Eber, Ernst; Steinbrugger, B; Weinhandl, Elisabeth; Ms, Zach

doi:10.1183/09031936.95.08101742

Cited by 19 publications

(16 citation statements)

References 19 publications

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“…Use of corticosteroids does not explain the difference in response to the indirect and direct challenge tests noted in some of our subjects, as we deliberately recruited steroid-naïve subjects because of the known effect of corticosteroids on AHR (11,12). Our results confirm (9,(13)(14)(15)(16) that the responses to direct and indirect challenges are not comparable. The population studied, as they were steroid naïve, were relatively mild asthmatics; it would be interesting to determine whether similar results were found in those with more severe disease.…”

Section: Discussionsupporting

confidence: 80%

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Cold Air and Exercise Challenge—Influence of Minute Ventilation

et al. 2007

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Exercises testing and cold air challenges are frequently used to assess airway hyperresponsiveness (AHR), but different goals are set for the two tests. We, therefore, wished to determine whether cold air and exercise challenge testing yielded similar responses and if any differences were due to differences in the maximum minute ventilation achieved. Twenty asthmatic subjects each performed a cold air (CACh) and an exercise (EXCh) challenge. Baseline forced expiratory volume in one second (FEV(1)) was recorded immediately pre-challenge and then serially for at least 10 minutes post-challenge. The maximum minute ventilation achieved was recorded. In the subjects who had at least a decrease in FEV(1) of 15% in response to the first CACh, a second CACh was performed, but at the maximum minute ventilation achieved during EXCh. Eleven subjects after CACh and four after EXCh had a greater than 15% decrease in FEV(1) (p = 0.05). The median decrease in FEV(1) was greater following the CACh (16.7%[25th to 75th percentile 10.4 to 19.9]) than the EXCh (6.9%[25th to 75th percentile 4.3 to 14.6]); (p = 0.0004). The median maximum minute ventilation achieved was greater with the CACh (89[66-141] L/min) than with the EXCh (61(40 to 102)L/min); (p < 0.0001). Only one of seven subjects who had previously responded to the CACh had a 15% decrease in FEV(1) when the CACh was repeated at the same maximum minute ventilation achieved during EXCh (p = 0.007). In conclusion, cold air and exercise challenges do not produce the same response. Our results highlight than an explanation is the differences in the maximum-minimum ventilation achieved.

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Section: Discussionsupporting

confidence: 80%

“…Therefore, we chose to use a single-step CACh, as this has been shown to be a suitable substitute in children (9). It was necessary, however, to modify the single step guidelines for the CACh set out by Sterk et al (6) for our study population, as some subjects were unable to maintain the required ventilation rate of 75% MVV for 4 minutes.…”

Section: Discussionmentioning

confidence: 98%

Cold Air and Exercise Challenge—Influence of Minute Ventilation

et al. 2007

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“…126 Two challenge protocols have been used: The first involves a single step, where subjects hyperventilate room air or cold air at MVV (FEV 1 × 25–35) for 3–6 minutes, and the second involves multiple steps, with increasing ventilation rates from 20% to 100% MVV. 127, 128 Exhaled air is continuously monitored by a carbon dioxide (CO 2 ) analyzer, which directs the addition of CO 2 to the inhaled air so that isocapnic (eucapnic) conditions are maintained throughout the challenge. Alternatively, the challenge can be conducted with air containing 5% CO 2 .…”

Section: Airway Responsivenessmentioning

confidence: 99%

Asthma outcomes: Pulmonary physiology

Tepper

Wise

Covar

et al. 2012

Journal of Allergy and Clinical Immunology

141

117

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Background Outcomes of pulmonary physiology have a central place in asthma clinical research. Objective At the request of National Institutes of Health (NIH) institutes and other federal agencies, an expert group was convened to provide recommendations on the use of pulmonary function measures as asthma outcomes that should be assessed in a standardized fashion in future asthma clinical trials and studies to allow for cross-study comparisons. Methods Our subcommittee conducted a comprehensive search of PubMed to identify studies that focused on the validation of various airway response tests used in asthma clinical research. The subcommittee classified the instruments as core (to be required in future studies), supplemental (to be used according to study aims and in a standardized fashion), or emerging (requiring validation and standardization). This work was discussed at an NIH-organized workshop in March 2010 and finalized in September 2011. Results A list of pulmonary physiology outcomes that applies to both adults and children older than 6 years was created. These outcomes were then categorized into core, supplemental, and emerging. Spirometric outcomes (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], and FEV1/FVC) are proposed as core outcomes for study population characterization, for observational studies, and for prospective clinical trials. Bronchodilator reversibility and pre- and post-bronchodilator FEV1 also are core outcomes for study population characterization and observational studies. Conclusions The subcommittee considers pulmonary physiology outcomes of central importance in asthma and proposes spirometric outcomes as core outcomes for all future NIH-initiated asthma clinical research.

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“…The repeatability of the method was evaluated within 4 weeks from the initial measurement in the 30 selected subjects. For this method a C FEV 1 of minus 9% or greater defines airway hyperresponsiveness (11).…”

Section: Cold Air Challengementioning

confidence: 99%

“…CACh was performed according to an established protocol as a single step 4-minutes isocapnic hyperventilation test, as previously described (11). Cold dry air was produced by a commercially available respiratory heat exchange system (RHES Jaeger Wuerzburg Germany).…”

Section: Cold Air Challengementioning

confidence: 99%

Isocapnic Cold Air Challenge in Patients with COPD: Are There any Predisposing Factors?

Κostikas

Koutsoumbou

Karamanis³

et al. 2008

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Cold air hyperventilation is an indirect challenge (cold air challenge, CACh) with high specificity and low sensitivity in defining asthmatic subjects. A small proportion of chronic obstructive pulmonary disease (COPD) patients present with positive CACh. The aim of this prospective study was to investigate the presence of factors related to cold air challenge (CACh) in COPD patients. Factors examined were FEV(1), FEV(1)/FVC, reversibility after bronchodilation, eosinophils in induced sputum, bronchial hyperresponsiveness to methacholine and the spirometric response to tiotropium compared to placebo. We studied 92 consecutive COPD patients in order to retrieve 15 CACh positive + patients. Fifteen COPD patients with negative CACh [CACh(-)], randomly selected from the initial group, were added in order to retrieve a group of 30 patients. Spearman's correlation coefficient was used in order to evaluate possible significant correlations between CACh values and study parameters. Sixteen percent of our subjects presented CACh+. CACh values were repeatable with an intraclass correlation coefficient between the two measurements 0.980 (95% CI 0.940-0.993). The only significant correlation observed was between Delta FEV(1) after CACh [Delta(C)FEV(1)] and trough FEV(1) values post tiotropium inhalation (r(2) = 0.62, p < 0.0001). When we analyzed the response to tiotropium in the 2 separate groups we found that patients with CACh+ presented significantly lower values of trough FEV(1) compared to those with CACh(-). In conclusion, a small proportion of COPD patients present with bronchial hyperresponsiveness to CACh. The only parameter related to CACh + in our study was a smaller bronchodilating effect of tiotropium.

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Comparing methods for assessing bronchial responsiveness in children: single step cold air challenge, multiple step cold air challenge, and histamine provocation

Cited by 19 publications

References 19 publications

Cold Air and Exercise Challenge—Influence of Minute Ventilation

Cold Air and Exercise Challenge—Influence of Minute Ventilation

Asthma outcomes: Pulmonary physiology

Isocapnic Cold Air Challenge in Patients with COPD: Are There any Predisposing Factors?

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