Effect of therapy on bronchial hyperresponsiveness in the long‐term management of asthma

Woolcock, Ann J.; Yan, Kwok; Salome, Cheryl M.

doi:10.1111/j.1365-2222.1988.tb02856.x

Cited by 151 publications

(46 citation statements)

References 19 publications

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“…Previous long-term studies have shown airway responsiveness to reach the normal range in only a small proportion of subjects [23,29,30], and the clinical and pathophysiological significance of this phenomenon is uncertain. In the present study, although 89% of subjects had moderate/ severe AHR on entry, 41% achieved a PD20 within the normal range by completion/withdrawal.…”

Section: Discussionmentioning

confidence: 96%

Optimal asthma control, starting with high doses of inhaled budesonide

et al. 2000

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The aim of this study was to determine whether outcomes in poorly controlled asthma can be further improved with a starting dose of inhaled budesonide higher than that recommended in international guidelines.The study had a parallel-group design and included 61 subjects with poorly controlled asthma, randomized to receive 3,200 mg or 1,600 mg budesonide daily by Turbuhaler1 for 8 weeks (double-blind), then 1,600 mg . day -1 for 8 weeks (single-blind), followed by 14 months of open-label budesonide dose down-titration using a novel algorithm, with a written asthma crisis plan based on electronic peak expiratory flow monitoring. The primary outcome variable for weeks 1±16 was change in airway hyperresponsiveness (AHR), and, for the open-label phase, mean daily budesonide dose.By week 16, there were large changes from baseline in all outcomes, with no significant differences between the 3,200-and 1,600-mg . day -1 starting dose groups (AHR increased by 3.2 versus 3.0 doubling doses, p=0.7; morning peak flow increased by 134 versus 127 L . min -1 , p=0.8). Subjects starting with 3,200 mg . day -1 were 3.8 times more likely to achieve AHR within the normal range, as defined by a provocative dose of histamine causing a 20% fall in forced expiratory volume in one second (PD20) of $3.92 mmol by week 16 (p=0.03). During dose titration, there was no significant difference in mean budesonide dose (1,327 versus 1,325 mg . day -1 , p>0.3). Optimal asthma control was achieved in the majority of subjects (at completion/withdrawal: median symptoms 0.0 days . week -1 , b 2 -agonist use 0.2 occasions . day -1 , and PD20 2.4 mmol).In subjects with poorly controlled asthma, a starting dose of 1,600 mg . day -1 budesonide was sufficient to lead to optimal control in most subjects. The high degree of control achieved, compared with previous studies, warrants further investigation. Eur Respir J 2000; 15: 226±235.

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Section: Discussionmentioning

confidence: 96%

Optimal asthma control, starting with high doses of inhaled budesonide

et al. 2000

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“…A avaliação da HRB inespecífica tem sido advogada como método capaz de avaliar a gravidade da asma 33 . Segundo alguns, os sintomas asmáticos e a HRB à metacolina estão diretamente relacionados e as crianças que apresentam HRB de maior intensidade representam um grupo de maior morbidade 9,34 .…”

Section: Discussionunclassified

“…Observamos, de modo significante, um gradiente inverso entre os valores de CPS e a intensidade do quadro clínico (Tabela 3), à semelhança de outros 9,10,[32][33][34][35] .…”

Section: Discussionunclassified

Non specific bronchial hyperreactivity in infants

Guirau

Solé²,

Naspitz³

1997

J Pediatr (Rio J)

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Objetivos: Avaliar a presença de hiper-reatividade brônquica (HRB) em "Bebês chiadores" (BC) e Controles normais (C) utilizando o teste de broncoprovocação (TBP) com metacolina (M).Métodos: Cinqüenta e um BC e 20 C, todos menores de 2 anos de idade, acompanhados no Departamento de Pediatria da UNI-FESP-EPM, foram submetidos a TBP com M, tendo a ausculta pulmonar como parâmetro de monitoragem para avaliação da CPS (concentração provocadora de sibilo). As concentrações de M inaladas foram: 0,025; 0,125; 0,25; 0,5; 1,0; 2,5; 5,0 e 10,0 mg/ml, tendo como veículo O 2 (5 l/min) por máscara facial. A concentração em que houve aparecimento de sibilo à ausculta pulmonar foi denominada de CPS.Resultados: Não foram observados efeitos colaterais durante os TBP em ambos os grupos, exceto por taquipnéia e taquicardia. A análise comparativa entre os valores da CPS dos BC (2,3 mg/ml) e dos C (9,2 mg/ml), e a freqüência de teste positivo (100% X 55%, respectivamente) revelaram valores significantemente distintos entre ambos (p < 0,05). Os desencadeamentos entre os BC ocorreram de modo significante a partir da concentração de 2,5 mg/ml, diferente dos C (p < 0,05). Considerando a concentração de 5,0 mg/ml, verificamos que 96% dos BC tiveram CPS menor ou igual a esta contra apenas 25% dos C, sendo a mesma considerada como concentração de corte, capaz de separá-los (p < 0,05). Considerando a gravidade do quadro inicial, observamos relação significante entre valores mais elevados da CPS e formas mais leves (p < 0,05).Conclusões: A determinação da CPS nos parece método adequado para demonstrar e avaliar o grau de HRB inespecífica em crianças de baixa idade, permitindo a distinção entre portadores de HRB e não portadores. É procedimento de fácil execução, seguro e bem tolerado pelas crianças. Estudos de seguimento são necessários para aclarar o real significado da CPS nesses pacientes.J. pediatr. (Rio J.). 1997; 73(1):37-42: asma, hiper-reatividade brônquica, broncoprovocação. AbstractObjective: To evaluate the presence of bronchial hyperreactivity (BHR) in Wheezing Babies (WB) and Normal Control Infants (C) employing the methacholine (M) bronchoprovocation test (BPT).Methods: Fifty-one WB and 20 C, all under two years old and assisted at the Department of Pediatrics of UNIFESP-EPM, were submitted to BPT with M, having pulmonary auscultation as monitoring parameter to evaluate PCW (provocative concentration of M causing wheezing). For all tests, M diluted in saline at increasing concentrations of: 0.025, 0.125, 0.25, 0.5, 1.0, 2.5, 5.0, and 10.0 mg/ ml was delivered with O 2 (5 l/min) by a face mask. It was inhaled through the mouth and nose during 2 minutes of quiet tidal breathing via nebulizer with 2 ml of solution.Results: None collateral effects were observed, except for tachypnea and tachycardia. There was statistically significant differences between WB (2.3 mg/ml) PCW value and C (9.2 mg/ml) (p < 0.05). At the PCW value of 2.5 mg/ml, 41% of the WB had statistically positive response (p < 0.05). This was not observed in the grou...

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“…[1][2][3][4] When combined with individualized treatment plans, monitoring has been shown to improve symptoms, decrease resource consumption, and favorably affect the physiologic processes implicated in asthmatic attacks. [5][6][7][8][9] We conducted a prospective, double-blind study to determine if PEFR monitoring could be of similar value in patients with advanced COPD.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Treatment programs based on these measurements have been shown to reduce symptoms, 5 the number of attacks, 6 days lost from work, 5,6 medication requirements, [5][6][7] airflow variability, 8,9 the response to histamine challenge, 8 and physician consultations and emergency department admissions. 6 Despite these successes, the role of peak flow monitoring in management of chronic obstructive pulmonary disease (COPD) is unknown.…”

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confidence: 99%

A multivariate model for predicting respiratory status in patients with chronic obstructive pulmonary disease

Murata

Kapsner²,

Lium³

et al. 1998

J Gen Intern Med

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OBJECTIVE:To develop and validate a multivariate model for predicting respiratory status in patients with advanced chronic obstructive pulmonary disease (COPD). DESIGN:Prospective, double-blind study of peak flow monitoring. SETTING: Albuquerque Veterans Affairs Medical Center. PATIENTS:Male veterans with an irreversible component of airflow obstruction on baseline pulmonary function tests. MEASUREMENTS:This study was conducted between January 1995 and May 1996. At entry, subjects were instructed in the use of the modified Medical Research Council Dyspnea Scale and a mini-Wright peak flow meter equipped with electronic storage. For the next 6 months, they recorded their dyspnea scores once daily and peak expiratory flow rates twice daily, before and after the use of bronchodilators. Patients were blinded to their peak expiratory flow rates, and medical care was provided in the customary manner. Readings were aggregated into 7-day sampling intervals, and interval means were calculated for dyspnea score and peak expiratory flow rate parameters. Intervals from all subjects were then pooled and randomized to separate groups for model development (training set) and validation (test set). In the training set, logistic regression was used to identify variables that predicted future respiratory status. The dependent variable was the log odds that the subject would attain his highest level of dyspnea in the next 7 days. The final model was used to stratify the test set into "high-risk" and "low-risk" categories. The analysis was repeated for 3-day intervals. MAIN RESULTS:Of the 40 patients considered eligible for study, 8 declined to participate, 4 could not master the technique of peak flow monitoring, and 6 had no fluctuations in their dyspnea level. The remaining 22 subjects form the basis of this report. Fourteen (64%) of the latter completed the 6-month protocol. Data from the 8 who were dropped or died were included up to the point of withdrawal. For 7-day forecasts, mean dyspnea score and mean daily prebronchodilator peak expiratory flow rate were identified as predictor variables. The adjusted odds ratio (OR) for mean dyspnea score was 2.71 (95% confidence interval [CI] 1.79, 4.12) per unit. For mean prebronchodilator peak expiratory flow rate, it was 1.05 (95% CI 1.01, 1.09) per percentage predicted. For 3-day forecasts, the model was composed of mean dyspnea score and mean daily bronchodilator response. The ORs for these terms were 2.66 (95% CI 2.06, 3.44) per unit and 0.980 (95% CI 0.962, 0.998) per percentage of improvement over baseline, respectively. For a given level of dyspnea, higher prebronchodilator peak expiratory flow rate and lower bronchodilator response were poor prognostic findings. When the models were applied to the test sets, "high-risk" intervals were 4 times more likely to be followed by maximal symptoms than "low-risk" intervals.CONCLUSIONS: Dyspnea scores and certain peak expiratory flow rate parameters are independent predictors of respiratory status in patients with COPD. However, our re...

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Effect of therapy on bronchial hyperresponsiveness in the long‐term management of asthma

Cited by 151 publications

References 19 publications

Optimal asthma control, starting with high doses of inhaled budesonide

Optimal asthma control, starting with high doses of inhaled budesonide

Non specific bronchial hyperreactivity in infants

A multivariate model for predicting respiratory status in patients with chronic obstructive pulmonary disease

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