Lack of a late asthmatic response after hypertonic saline challenge in children

Eder, Waltraud; Schreuer, Mynda; Riedler, Josef

doi:10.1183/09031936.99.14511799

Cited by 2 publications

(3 citation statements)

References 27 publications

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“…This suggests that transient ASF hypertonicity alone is insufficient to cause the development of late-phase airway obstruction. This observation is consistent with a recent study by Eder et al (5) showing that HSC did not cause late-phase changes in airway function in children. However, that study examined changes in forced expired volume in 1 s only and did not evaluate other hallmarks of a late-phase response, such as inflammation or airway hyperresponsiveness.…”

Section: Discussionsupporting

confidence: 93%

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Hypertonic saline aerosol increases airway reactivity in the canine lung periphery

Suzuki

Freed

2000

Journal of Applied Physiology

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Hyperventilation with dry air increases airway surface fluid (ASF) osmolality and causes acute mucosal injury, leukocyte infiltration, and delayed airway obstruction and hyperreactivity in canine peripheral airways. The purpose of this study was to determine whether ASF hypertonicity per se can account for these hyperventilation-associated effects. We first measured ASF osmolality before and after normal (NSC) and hypertonic (HSC) saline aerosol challenges to document the magnitude of hypertonicity produced by these stimuli. We then measured canine peripheral airway resistance and reactivity to hypocapnia and aerosolized histamine before and after NSC and HSC. Cells and eicosanoid mediators recovered in bronchoalveolar lavage fluid at 5 and 24 h after NSC and HSC were examined. We found that HSC but not NSC caused acute ASF hyperosmolality, increased mediator release, and delayed airway hyperreactivity in the absence of mucosal injury and leukocyte infiltration. These observations suggest that ASF hyperosmolality contributes to the development of the late-phase response to hyperventilation and further suggest that hyperventilation-induced mucosal injury independently initiates leukocyte infiltration and late-phase airway obstruction.

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Section: Discussionsupporting

confidence: 93%

“…Thus, despite the fact the HSC does not initiate late-phase changes in baseline lung function in either dogs (Fig. 3) or asthmatic humans (5), it does produce a delayed increase in canine peripheral airways reactivity and may have a similar effect in human subjects.…”

Section: Discussionmentioning

confidence: 89%

Hypertonic saline aerosol increases airway reactivity in the canine lung periphery

Suzuki

Freed

2000

Journal of Applied Physiology

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“…In addition, provocation with hypertonic saline is preferable to the inhalation of pharmacological substances from an ethical point of view. Furthermore, the 4.5% saline challenge test yields good reproducibility in children with asthma (14) and there is no late asthmatic response in subjects with mild to moderate bronchial hyperreactivity (15).…”

Section: Discussionmentioning

confidence: 99%

Hypertonic saline challenge tests in the diagnosis of bronchial hyperresponsiveness and asthma in children

Mai

Nilsson

Kjellman

et al. 2002

Pediatric Allergy Immunology

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The hypertonic saline challenge test is the recommended method to assess bronchial hyperresponsiveness in the International Study of Asthma and Allergies in Childhood (ISAAC). The sensitivity of this procedure to assess asthma symptoms, however, has been reported to vary among study centers. The purpose of our study was to evaluate the value of this provocation test in an epidemiological survey in children, and to relate the degree of bronchial hyperresponsiveness to the severity of asthma symptoms. All 11-13-year-old children from 16 randomly selected schools in Linköping, Sweden received a questionnaire regarding respiratory symptoms and allergic disease. Skin prick tests with eight inhalant allergens were performed. In addition, all children with wheeze over the past 12 months (current wheeze) and a random sample of children without current wheeze were invited to perform hypertonic saline provocation tests. A complete data set was available for 170 children, including 50 with and 120 without current wheeze. Bronchial hyperresponsiveness (BHR) was defined as at least 15% decline in FEV1. The degree of BHR was represented by the response/dose ratio, i.e. the fall in FEV1 divided by total dose of inhaled saline. The severity of asthma symptoms was classified by the number of wheezing episodes over the past 12 months. 'Asthma ever' was defined by a combination of symptoms in the questionnaires. Children with 'asthma ever' and current wheeze were considered as having current asthma. Current atopic asthma was defined as current asthma with at least one positive skin prick test. The sensitivity of the procedure to detect 'asthma ever', current asthma and current atopic asthma was 62, 61 and 83%, and the specificity 83, 81 and 60%, respectively. The positive challenge rate was 52, 34, 13 and 7% among current wheezers, previous wheezers, non-wheezers with a history of allergy and healthy children. The degree of bronchial hyperresponsiveness increased with the number of wheezing episodes. Thus, the median and range of the response/dose ratio were 4.8%/ml (2.1-14.8), 2.6%/ml (0.7-8.6) and 1.3%/ml (0.8-2.7), respectively, for children with >/= 4 episodes, 1-3 episodes and no wheezing episodes over the past 12 months (p<0.001). In conclusion, hypertonic saline provocation test is useful as a tool to detect asthma in epidemiological studies in children. The degree of bronchial hyperresponsiveness, as represented by the response/dose ratio, reflects the severity of asthma symptoms.

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Lack of a late asthmatic response after hypertonic saline challenge in children

Cited by 2 publications

References 27 publications

Hypertonic saline aerosol increases airway reactivity in the canine lung periphery

Hypertonic saline aerosol increases airway reactivity in the canine lung periphery

Hypertonic saline challenge tests in the diagnosis of bronchial hyperresponsiveness and asthma in children

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