Direct or indirect stimuli for bronchial challenge testing: what is the relevance for asthma epidemiology?

Meer, Gea de; Marks, Guy B.; Postma, Dirkje S.

doi:10.1111/j.1365-2222.2004.01830.x

Cited by 33 publications

(30 citation statements)

References 131 publications

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“…The inflammatory mediator release originating from airway mast cells plays an integral role in the response to inhaled AMP [6]. Clinical studies in asthma patients have shown that AHR to AMP reflects an underlying eosinophilic or atopic airway inflammation more accurately than AHR to methacholine [21,26].…”

Section: Discussionmentioning

confidence: 99%

“…AHR is usually measured by bronchial challenges using direct or indirect stimuli. Methacholine acts directly at the level of bronchial smooth muscle, whereas adenosine 59-monophosphate (AMP) acts indirectly, causing primed mast cell degranulation and the release of pro-inflammatory mediators [6]. It has been shown that AHR to methacholine is present both in asthma and in chronic lung diseases, whereas AHR to AMP is present only in asthma [7,8].…”

mentioning

confidence: 99%

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Methacholine and adenosine 5'-monophosphate challenges in children with post-infectious bronchiolitis obliterans

Yoo

Kim

et al. 2006

European Respiratory Journal

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Airway hyperresponsiveness (AHR) is a characteristic feature of asthma, but is also frequently demonstrated by children and adults with chronic obstructive lung diseases. AHR is usually measured by bronchial challenges using direct or indirect stimuli. The aim of this study was to compare these two types of bronchial challenge in children with post-infectious bronchiolitis obliterans (BO).Methacholine and adenosine 59-monophosphate (AMP) challenges were used as tools for the evaluation of AHR to direct and indirect stimuli, respectively, in children with post-infectious BO (n528). These results were compared with those of asthmatic (n530) and control children (n525).Altogether, twenty-two patients (78.6%) with post-infectious BO were hyperreactive to methacholine with a provocative concentration causing a 20% fall in forced expiratory volume in one second (PC20) of ,16 mg?mL -1 , but only six (21.4%) were hyperreactive to AMP with a PC20of ,200 mg?mL -1. All patients with asthma responded positively to methacholine, and most (28, 93.3%) also responded positively to AMP. The majority of controls were insensitive to both challenges.Airway hyperresponsiveness to methacholine is a frequent, but by no means universal, finding in children with post-infectious bronchiolitis obliterans, but is usually not accompanied by airway hyperresponsiveness to adenosine 59-monophosphate. This finding suggests that airway hyperresponsiveness in patients with post-infectious bronchiolitis obliterans has characteristics that differ from those of asthmatic subjects.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Methacholine and adenosine 5'-monophosphate challenges in children with post-infectious bronchiolitis obliterans

Yoo

Kim

et al. 2006

European Respiratory Journal

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“…Direct stimuli, such as with methacholine, induce airway narrowing mainly through direct action on the receptors of airway smooth muscles [2], whereas indirect stimuli, such as with adenosine 5′-monophosphate (AMP), cause airway narrowing mainly via the stimulation of primed mast-cell degranulation and the release of proinflammatory mediators [3]. Thus, airway inflammation also appears to be a major factor determining the degree of AHR and airflow obstruction.…”

Section: Introductionmentioning

confidence: 99%

Exhaled Nitric Oxide and Airway Hyperresponsiveness to Adenosine 5′-monophosphate and Methacholine in Children with Asthma

Perzanowski

Yoo²

2015

Int Arch Allergy Immunol

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Background: There is increasing interest in the role of indirect bronchial challenges because clinical studies have shown that indirect airway hyperresponsiveness (AHR) reflects underlying airway inflammation better than direct AHR. Fractional exhaled nitric oxide (FeNO) appears to be a useful clinical tool for assessing airway inflammation noninvasively. We examined whether FeNO is more closely related to AHR to indirect stimuli than AHR to direct stimuli in children with mild to moderate asthma. Methods: Fifty-nine asthmatic children aged 6-16 years without rhinitis, underwent spirometry, FeNO measurement and blood tests for serum total IgE, blood eosinophil count and serum eosinophil cationic protein (ECP). All subjects underwent methacholine and adenosine 5-monophosphate (AMP) challenge tests at intervals of 3 days. Results: In a univariate linear regression analysis, FeNO was significantly associated with both PC₂₀ AMP (R² = 0.341, p < 0.001) and PC₂₀ methacholine (R² = 0.188, p = 0.001). After adjustment for age, sex, serum total IgE and blood eosinophil count, the association between FeNO and PC₂₀ AMP (β = -1.98, p = 0.001) was more robust than that between FeNO and PC₂₀ methacholine (β = -0.87, p = 0.081). The significant correlation between FeNO and PC₂₀ AMP was observed in the steroid-naïve group (β = -2.48, p = 0.001), but not in the steroid-treated group (β = 0.88, p = 0.463). Conclusions: FeNO levels were more closely associated with PC₂₀ AMP than with PC₂₀ methacholine. This relationship could only be seen in the steroid-naïve subjects. These results suggest that FeNO levels in children with asthma may be more closely related to indirect AHR than to direct AHR.

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“…BHR is most commonly evaluated using methacholine or histamine, which acts directly at the level of bronchial smooth muscle. However, BHR can also be assessed using indirect stimuli, such as adenosine 5'-monophosphate (AMP), which causes bronchoconstriction by stimulating or enhancing the release of mediators from mast cells [4]. There is increasing interest in the role of indirect bronchial challenges because symptoms and bronchoconstriction occur in clinical asthma by means of indirect mechanisms [5].…”

mentioning

confidence: 99%

Bronchial hyperresponsiveness to methacholine/AMP and the bronchodilator response in asthmatic children

Suh¹,

Lee²,

Kim³

et al. 2010

Eur Respir J

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Bronchodilator response (BDR) is assessed to estimate the reversibility of airflow obstruction. Bronchial hyperresponsiveness (BHR) is a characteristic feature of asthma and is usually measured by means of bronchial challenges using direct or indirect stimuli. The aim of the present study was to compare BHR to methacholine (direct) and that to adenosine 5'-monophosphate (AMP) (indirect) with regard to their relationships to BDR in asthmatic children.Methacholine and AMP challenge tests were performed on 138 children with mild-to-moderate asthma, and the provocative concentration causing a 20% decline in forced expiratory volume in 1 s (FEV1) (PC20) was determined for each challenge. BDR was calculated as the change in FEV1, expressed as a percentage of the initial value, after inhalation of 400 mg salbutamol.Methacholine PC20 correlated significantly but weakly with BDR (r5 -0.254; p50.003). However, there was a significant and strong correlation between AMP PC20 and BDR (r5 -0.489; p50.000). For AMP PC20, the relationship was closer than for methacholine PC20 (p50.024 for comparison between correlation coefficients). The same figures were observed when BDR was expressed as a percentage of the predicted value.A stronger correlation of BDR with AMP PC20 than with methacholine PC20 suggests that BDR may be better reflected by BHR as assessed by AMP challenge than by methacholine challenge.

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Direct or indirect stimuli for bronchial challenge testing: what is the relevance for asthma epidemiology?

Cited by 33 publications

References 131 publications

Methacholine and adenosine 5'-monophosphate challenges in children with post-infectious bronchiolitis obliterans

Methacholine and adenosine 5'-monophosphate challenges in children with post-infectious bronchiolitis obliterans

Exhaled Nitric Oxide and Airway Hyperresponsiveness to Adenosine 5′-monophosphate and Methacholine in Children with Asthma

Bronchial hyperresponsiveness to methacholine/AMP and the bronchodilator response in asthmatic children

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