Determination of airway hyper‐reactivity in asthmatic children: A comparison among exercise, nebulized water, and histamine challenge

Fourie, Paula; Joubert, James R.

doi:10.1002/ppul.1950040103

Cited by 28 publications

(15 citation statements)

References 18 publications

(1 reference statement)

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“…There is a weak, if statistically significant, correlation between EIB and log histamine, or methacholine PC20 [142,143]. Exercise challenge, to a preset threshold, is consistently less sensitive but more specific than the direct challenges in differentiating asthma from normal [142][143][144][145][146][147][148][149]. There are many asthmatics with mild bronchial hyperresponsiveness to direct stimuli who have negative exercise challenges but there are individuals who have positive exercise challenges and negative histamine or methacholine challenges [150].…”

Section: Diagnostic Value Of Indirect Challengesmentioning

confidence: 99%

Indirect airway challenges

Joos

O’Connor²,

Anderson³

et al. 2003

Eur Respir J

325

274

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Indirect challenges act by causing the release of endogenous mediators that cause the airway smooth muscle to contract. This is in contrast to the direct challenges where agonists such as methacholine or histamine cause airflow limitation predominantly via a direct effect on airway smooth muscle.Direct airway challenges have been used widely and are well standardised. They are highly sensitive, but not specific to asthma and can be used to exclude current asthma in a clinic population. Indirect bronchial stimuli, in particular exercise, hyperventilation, hypertonic aerosols, as well as adenosine, may reflect more directly the ongoing airway inflammation and are therefore more specific to identify active asthma. They are increasingly used to evaluate the prevalence of bronchial hyperresponsiveness and to assess specific problems in patients with known asthma, e.g. exercise-induced bronchoconstriction, evaluation before scuba diving.Direct bronchial responsiveness is only slowly and to a modest extent, influenced by repeated administration of inhaled steroids. Indirect challenges may reflect more closely acute changes in airway inflammation and a change in responsiveness to an indirect stimulus may be a clinically relevant marker to assess the clinical course of asthma. Moreover, some of the indirect challenges, e.g. hypertonic saline and mannitol, can be combined with the assessment of inflammatory cells by induction of sputum.

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Section: Diagnostic Value Of Indirect Challengesmentioning

confidence: 99%

Indirect airway challenges

Joos

O’Connor²,

Anderson³

et al. 2003

Eur Respir J

325

274

View full text Add to dashboard Cite

show abstract

“…Exercise may prove to be an alternative challenge for epidemiology studies because it is feasible, acceptable and reliable. Although exercise and inhalation (histamine, methacholine) challenges have been compared in relatively small samples studied in the laboratory [3][4][5][6][7], these studies have used only well defined 'asthmatics' and 'normals', in whom the diagnosis was not in question. No previous comparisons between exercise and histamine have been conducted in the field, in subjects with a full range of severity of asthma, or in subjects in whom the diagnosis was in doubt.…”

Section: Discussionmentioning

confidence: 99%

“…Studies in the laboratory suggest that some children with asthmatic symptoms respond to an exercise challenge but not to methacholine or histamine and vice versa [3][4][5][6]. However, the concordance between positive responses to exercise and to histamine or methacholine in field studies has not been documented.…”

mentioning

confidence: 99%

An exercise challenge protocol for epidemiological studies of asthma in children: comparison with histamine challenge

Haby

Anderson²,

Peat³

et al. 1994

Eur Respir J

122

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We investigated whether an exercise challenge protocol is suitable for measuring bronchial responsiveness in epidemiological studies of asthma in children, and determined its comparability with histamine challenge. The exercise challenge was 6 minutes of outdoor, free-range running at 85-90% of maximum heart rate, measured by heart rate monitor. Nose clips were worn. Distance run was measured to estimate oxygen consumption. Water content of the inspired air was < 10 mg H2O.l-1. Histamine challenge was by the rapid method. We used questionnaires to measure respiratory symptoms and skin prick tests to measure atopy. A total of 96 children aged 8-11 years were studied. Bronchial hyperresponsiveness (BHR) to exercise challenge was defined as a fall in forced expiratory volume in one second (FEV1) of 13% of greater. Eleven children had a positive response to exercise challenge and 11 to histamine challenge but 12 responded to one challenge and not to the other. The correlation coefficient between the two tests was 0.65 (p = 0.0001). Exercise challenge thus proved to be a practical epidemiological tool for objective measurements of bronchial responsiveness in children. In this sample, some children responded to one challenge and not to the other which suggests that the two challenges identify different abnormalities of the airways.

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“…Comparisons of exercise challenges for EIB with histamine and methacholine challenges in asthmatic patients show that exercise challenges are consistently less sensitive but more specific than chemical challenges in detecting EIB [91][92][93][94][95][96][97]. Many asthmatics (,30%) with mild bronchial hyperresponsiveness to chemical stimuli have negative responses to exercise challenges, but there are individuals who have positive responses to exercise challenges and negative responses to histamine or methacholine challenges [98].…”

Section: Arterial Oxygen Desaturation During Exercisementioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

537

390

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Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

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Determination of airway hyper‐reactivity in asthmatic children: A comparison among exercise, nebulized water, and histamine challenge

Cited by 28 publications

References 18 publications

Indirect airway challenges

Indirect airway challenges

An exercise challenge protocol for epidemiological studies of asthma in children: comparison with histamine challenge

Recommendations on the use of exercise testing in clinical practice

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