Comparison of two standardized methods of methacholine inhalation challenge in young adults

Siersted, Hans Christian; Walker, Carl; O'Shaughnessy, A D; Willan, Andrew R.; Wiecek, Elizabeth M.; Sears, Malcolm R.

doi:10.1183/09031936.00.15118100

Cited by 20 publications

(3 citation statements)

References 11 publications

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“…The two methods seem to be equivalent. 18 All participants had complete data and we needed to eliminate only one subject from the analyses. There were proportionally more women than men in the study as it was more difficult to find men and to obtain their consent for the study.…”

Section: Discussionmentioning

confidence: 99%

Is there a causal relation between obesity and asthma? Evidence from Chile

et al. 2005

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OBJECTIVE: An association between obesity and asthma symptoms has been reported in the literature, but such a relationship is inconsistent if atopic status or bronchial hyper responsiveness (BHR) is considered. The objective was to assess the association between obesity and asthma symptoms or BHR in adults. METHODS: A study was carried out in 1232 people born between 1974 and 1978 in Chile. The participants completed the European Community Health Survey questionnaire, were skin tested and subject to a BHR challenge to methacholine. MEASUREMENTS: Weight, height and waist circumference were measured and body mass index (BMI) was calculated. RESULTS: There was a positive association between wheeze and breathlessness following exercise and BMI (both with an OR 1.03, 95% CI 1.00-1.06), the associations with wheeze tended to disappear in women who did react at least to one allergen, and persisted in those who did not react to any allergens. BMI was negatively associated with BHR (OR 0.93, 95% CI 0.89-0.97). Waist circumference was not associated with asthma symptoms and it was negatively associated with BHR. CONCLUSION: Although there was an association between BMI and asthma symptoms, there were weaknesses in the evidence because waist circumference, a more direct measure of obesity than BMI, was not associated with asthma symptoms, and BMI and waist circumference were negatively associated with BHR.

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Section: Discussionmentioning

confidence: 99%

Is there a causal relation between obesity and asthma? Evidence from Chile

et al. 2005

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“…However, the variety of devices used, the delivery of different methacholine doses, the small sample size and the inability to directly compare cutoffs (comparing PC 20 of the tidal breathing to PD 20 of the dosimeter) may have an impact on the overall agreement and limit what could be concluded. 16,25,26 There is emerging evidence that to better compare MCT methods, PD 20 were not due to a changing referral pattern. Furthermore, we do not have information on the technical perfomace such as the nebulizer output and the mass median diameter (MMD) were constant over the time period of each test and the study period.…”

Section: Discussionmentioning

confidence: 99%

Methacholine challenge test: Comparison of tidal breathing and dosimeter methods in children

Mazi

Lands

Zielinski

2017

Pediatric Pulmonology

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“…Methacholine solutions, diluted in 0.9% saline and sterilised, were prepared by the study pharmacist in doubling concentrations from 0.03-256 mg?mL , using the methodology established by JUNIPER et al [16] and SIERSTED et al [18]. Starting concentrations of methacholine (0.03-0.125 mg?mL -1 ) were determined by the investigator for each patient, based on inhaled corticosteroid therapy and the response to 0.9% sterile saline.…”

Section: Methacholine Challengementioning

confidence: 99%

Protection against methacholine-induced bronchospasm: salbutamol pMDIversusClickhaler® DPI

Newhouse¹,

Patel²,

Parry-Billings³

2003

Eur Respir J

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Protection against methacholine-induced bronchospasm: salbutamol pMDI versus Clickhaler1 DPI. M.T. Newhouse, P. Patel, M. Parry-Billings. #ERS Journals Ltd 2003. ABSTRACT: Passive dry-powder inhalers (DPIs) have been developed as an alternative to pressurised metered-dose inhalers (pMDIs) to improve aerosol delivery on inhalation and eliminate the need for propellants. However, new DPI formulations of generic drugs must be rigorously compared with conventional pMDI therapy.This randomised, double-blind, double-dummy, placebo-controlled, seven-way crossover study evaluated bronchoprotection from methacholine challenge in order to compare a novel salbutamol DPI (Clickhaler1) with a reference salbutamol pMDI (Ventolin1). Adult asthma patients with airway hyperresponsiveness to methacholine (provocative concentration of methacholine causing a 20% fall in the forced expiratory volume in one second (PC20) v4 mg?mL -1 ) were treated on separate days with 0, 100, 200 or 400 mg of salbutamol via the DPI or pMDI. Methacholine challenge was performed before and after salbutamol treatment and the PC20 ratios analysed by Finney9s bioassay to test for therapeutic equivalence of the inhalers.Eighteen patients completed the study and showed significant dose-related responses to salbutamol. The relative potency of DPI:pMDI was 1.29 (90% confidence interval 1.04-1.63). There were no treatment differences in safety (cardiac frequency, blood pressure, adverse events).Methacholine-challenge methodology provides a sensitive bioassay and has demonstrated therapeutic equivalence of the salbutamol Clickhaler1 dry-powder inhaler with the conventional salbutamol pressurised metered-dose inhaler. Salbutamol, the b 2 -agonist bronchodilator most commonly used in the treatment of asthma, has been administered using pressurised metered-dose inhalers (pMDIs) and pressurised chlorofluorocarbon (CFC) propellants for the past 30 yrs. Substituting "ozone-friendly" alternatives puts the onus on the pharmaceutical industry to produce cost-effective replacement inhalers and establish that the switch-over from CFC pMDIs does not compromise patient care [1]. Each new device/formulation is a unique combination that must satisfy strict regulatory requirements [2].Pharmaceutical research and development has followed two major pathways: upgrading pMDIs with hydrofluoroalkanes (HFAs) as chlorine-free propellants, and innovative design of efficient dry-powder inhalers (DPIs) [3,4]. The activity of inhaled medications in the lung is determined by the amount of drug entering the lower respiratory tract [5], which is dependent on the mass of particles of y1-5 mm diameter and inspiratory flow velocity through the device [6]. Changes of formulation, humidity, device or handling may alter drug mass or deposition, with implications for both safety and efficacy [7][8][9]. Rapid systemic absorption of inhaled salbutamol occurs mainly at the vascular lung surface and the risk:benefit ratio can change with improved deposition [10]. In-vitro data therefore need the supp...

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Comparison of two standardized methods of methacholine inhalation challenge in young adults

Cited by 20 publications

References 11 publications

Is there a causal relation between obesity and asthma? Evidence from Chile

Is there a causal relation between obesity and asthma? Evidence from Chile

Methacholine challenge test: Comparison of tidal breathing and dosimeter methods in children

Protection against methacholine-induced bronchospasm: salbutamol pMDIversusClickhaler® DPI

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