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PubMed1998

Bronchodilator response to salbutamol after spontaneous recovery from nonspecific bronchial provocation tests in asthma.

Assessment of airway responsiveness by bronchoprovocation and bronchodilatation tests is important in the diagnostic work-up protocol of bronchial asthma and it would be convenient to undertake both tests on the same occasion. However, it is not known whether this can be done accurately. Therefore, this study evaluated the effect of a prior bronchial provocation test on the bronchodilator response to salbutamol after spontaneous recovery of the forced expiratory volume in one second (FEV1) in a group of asthmatic subjects. On two separate occasions at the same time of day, concentration-response studies with inhaled histamine or methacholine, or a sham challenge with normal saline were carried out in a blinded, randomized manner. Changes in airway calibre were followed as FEV1 and agonist responsiveness expressed as the provocative concentration causing a 20% fall in FEV1 (PC20). After either spontaneous recovery or a fixed-duration wait of 45 min (when appropriate), the subjects received 2x100 microg of salbutamol from a metered dose inhaler with a spacer. The bronchodilator response to salbutamol was expressed as a percentage of initial FEV1 (deltaFEV1% init). Bronchial challenge with both agonists failed to alter significantly the airway response to salbutamol, with the deltaFEV1% init mean value (range) being 16.9% (9.0-31.9) and 17.5% (11.6-31.2) on the sham and histamine/methacholine challenge day respectively. It was shown that the degree of bronchodilatation achieved after salbutamol 200 microg is not affected by prior bronchoprovocation testing when enough time is allowed for the airways to recover spontaneously to baseline forced expiratory volume in one second. Thus evaluation of airway responsiveness by both bronchial provocation tests and bronchodilator testing can be assessed reliably within a few hours in asthmatic patients.

Adolescent↗
PubMed1996

[Usefulness of allergen extract Aquagen SQ-Dpt for administering bronchial provocation tests].

The value of the allergen extract, Aquagen SQ-Dpt, for performance of the bronchial provocation test in allergic asthma patients was evaluated. The studies were carried out on 117 patients suffering from allergic mite asthma. Bronchial challenge was performed according to Ryan's method. After an allergen inhalation, an early asthmatic reaction (EAR) and a late asthmatic reaction (LAR) may appear. In our studies a dual reaction (EAR and LAR) was observed in 53.8% of the patients, the EAR only in 27.4% and the LAR only in 2 patients. The subjects with the dual response demonstrated a higher sensitivity to the allergen than those with only the EAR. A positive, statistically significant correlation between specific and non-specific bronchial hyperreactivity was found. The frequency of the appearance particular patterns of the bronchial responses was similar to those published by other authors, using different allergen extracts. Aquagen SQ-Dpt can be used to perform of the sBPT.

Adult↗
PubMed1989

A study of the bronchial provocation test with methacholine in patients with active pulmonary tuberculosis.

Bronchial hyperreactivity is a characteristic feature of bronchial asthma. Recent respiratory infections, allergic rhinitis, atopic family history, pulmonary tuberculosis, pulmonary sarcoidosis, cystic fibrosis, and farmer's lung have also been demonstrated to have bronchial hyperreactivity to inhaled methacholine. It is not known if pulmonary tuberculosis can cause nonspecific bronchial hyperreactivity and what the mechanism would be. We therefore undertook to evaluate nonspecific bronchial hyperreactivity in active pulmonary tuberculosis using the bronchial provocation test with methacholine and we measured the total serum IgE and peripheral eosinophil count to seek some mechanisms. There were 5 patients among 18 subjects with active pulmonary tuberculosis whose response to methacholine was positive. The mean baseline FEV1 of positive responders was 71.40 +/- 17.39%, and that of negative responders was 110.18 +/- 17.65% (p less than 0.05). There were no significant differences in serum IgE and peripheral eosinophil count between positive and negative responders. We found that active pulmonary tuberculosis would increase the nonspecific bronchial response with methacholine, and the mechanism of the bronchial hyperreactivity in patients with active pulmonary tuberculosis may not be related to an immunologic mechanism but may be related to the stimulating receptors.

Acute Disease↗
PubMedDate not supplied

[Preventive measures in bronchial provocation tests].

The author's own experiences together with the data from the literature are presented for application the bronchial provocation tests in the hospital and in out-patient's department for pulmonary disease. Contraindications and side effects in testing the nonspecific provocative agents are presented (metacholine, histamine, carbachol), in specific provocative agents as well as in exercise testing. These tests are relatively harmless if the preventive measures are taken into account.

Bronchial Provocation Tests↗
PubMedDate not supplied

[Physical exercise-induced bronchospasm in asthmatic children. Clinical usefulness of the specific free-running bronchial provocation test].

Exercise-induced bronchospasm (E.I.B.) is frequently observed in children. Here are reported the correlation between E.I.B. and some clinical-anamnestical parameters found in a group of thirty-eight asthmatic children examined by exercise. The aspecific bronchial provocation test was performed with six minutes free-running. The exercise-induced bronchospasm was estimated by bronchial obstruction index (b.o.i.). All the children were tested at 4 p.m., out of attacks, without clinical signs of airway obstruction, with basal pick-flow rate (PEFR) at least 80% of predicted. We have looked for the possible correlations between E.I.B. and the following parameters: sex, exercise-induced asthma, house heating, season, period of clinical remission, length of the disease and number of attacks per year. These results indicate that bronchial provocation test with free-running is useful in asthmatic children to objectify the bronchial hyperreactivity and to follow-up the course of the disease.

Adolescent↗
PubMed1985

Bronchial provocation tests with RAST-standardized allergens and dosimetric technique.

58 patients with proven allergic asthma (positive prick and RAST) were challenged with allergen extracts dosed in RAST arbitrary units; 14 of them were rechallenged after some months to evaluate the reproducibility of results; 41 underwent also a nonspecific challenge with methacholine. The results of the specific bronchial provocation test were well reproducible, with similar coefficients of variation for both early and late reactions. The specific bronchial provocation test was found to be more related to the allergic status, as reflected by specific IgE levels, than to nonspecific bronchial hyperreactivity, as reflected by response to methacholine.

Adolescent↗
PubMed1987

[Bronchial provocation tests in 59 asthmatic children. Comparison with skin tests and specific serum allergens].

Fifty nine asthmatic children were assessed by skin tests (prick-tests) (TC), specific serum IgE level (R.A.S.T.) and bronchial provocation tests (TPB) with house dust, mites, grass pollen, animal scales and moulds. The concordance of the skin and R.A.S.T. tests with the provocation test, chosen for reference and their diagnostic value was analysed using decision matrices. There was a significant connection between the results of the three tests. The concordance level was only moderate not passing 68%. By comparison to TPB there were numerous false positive Prick-tests and false negative R.A.S.T. The negative predictive value of TC was satisfactory. The most discriminatory threshold for the positive R.A.S.T. was the class 3 response. These results allow the following diagnostic possibilities to be considered. For a common allergen a negative prick-test (TC) would lead to the end of the investigations except for certain particular cases; for an allergen of low prevalence a positive TC should be taken into account, and completing this with RAST and TPB. One could envisage a reduction in the number of TPB and R.A.S.T. performed, reserving them for cases where a discordance between the clinical history and the T.C.

Adolescent↗
PubMed1991

[Bronchial provocation tests using bacterial suspensions in patients with bronchial asthma treated with autologous vaccines].

In 15 patients with non-atopic bronchial asthma bronchial aspirates were carried out. Bacterial strains were isolated from the aspirates and used to produce material for provocation tests andautologous vaccines. Bronchoprovocation was carried out twice--before and after treatment with autovaccines. A decrease in bronchial reactivity was seen after treatment with autologous vaccines. The improvement in spirometric indices was accompanied by clinical improvement in 11 out of the 15 treated cases (73.3%).

Adult↗
PubMed2005

The safety and efficacy of inhaled dry powder mannitol as a bronchial provocation test for airway hyperresponsiveness: a phase 3 comparison study with hypertonic (4.5%) saline.

BACKGROUND: Inhaled mannitol is a new bronchial provocation test (BPT) developed to improve portability and standardisation of osmotic challenge testing. Osmotic challenge tests have an advantage over the traditional methods of measuring airway hyperresponsiveness using methacholine as they demonstrate higher specificity to identify asthma and thus the need for treatment with inhaled corticosteroids (ICS). The safety and the efficacy of mannitol (M) as a BPT to measure airway hyperresponsiveness were compared to hypertonic (4.5%) saline (HS) in people both with and without signs and symptoms of asthma. METHODS: A phase III, multi-centre, open label, operator-blinded, crossover design, randomised trial, with follow-up. Asthmatics and non-asthmatics (6-83 yr) were recruited and 592 subjects completed the study. Mannitol was delivered using a low resistance dry powder inhaler and HS was delivered using an ultrasonic nebuliser. The FEV1 was measured 60 seconds after each dose of mannitol (5,10,20,40,80,160,160,160 mg) and after each exposure to HS (0.5,1.0,2.0,4.0,8.0 minutes). A 15% fall in FEV1 defined a positive test. Adverse events were monitored and diaries kept for 7 days following the tests. RESULTS: Mean pre-test FEV1 (mean +/- SD) was 95.5 +/- 14% predicted. 296 were positive to mannitol (M+) and 322 positive to HS (HS+). A post study physician conducted clinical assessment identified 82.3% asthmatic (44% classified mild) and 17.7% non-asthmatic. Of those M+, 70.1% were taking ICS and of those mannitol negative (M-), 81.1 % were taking ICS. The % fall in FEV1 for mannitol in asthmatics was 21.0% +/- 5.7 and for the non-asthmatics, 5.5% +/- 4.8. The median PD15 M was 148 mg and PD15 HS 6.2 ml. The sensitivity of M to identify HS+ was 80.7% and the specificity 86.7%. The sensitivity of M compared with the clinical assessment was 59.8% and specificity 95.2% and increased to 88.7% and 95.0% respectively when the M- subjects taking ICS were excluded. Cough was common during testing. There were no serious adverse events. The diarised events were similar for mannitol and HS, the most common being headache (17.2%M, 19%HS), pharyngolaryngeal pain (5.1%M, 3%HS), nausea (4.3%M, 3%HS), and cough (2.2%M, 2.4%HS). CONCLUSION: The efficacy and safety of mannitol was demonstrated in non-asthmatic and clinically diagnosed asthmatic adults and children.

Administration, Inhalation↗
PubMed2000

Occupational allergic airbone contact dermatitis and delayed bronchial asthma from epoxy resin revealed by bronchial provocation test.

Diglycidyl ether of bisphenol A (DGEBA) epoxy resins belong to the most common causes of occupational allergic contact dermatitis. DGEBA has on rare occasions caused occupational asthma. Here we present a patient who first developed occupational allergic contact dermatitis (ACD) caused by a single accidental exposure to DGEBA. Then, on continued occupational exposure to DGEBA, the patient developed occupational asthma from DGEBA, in addition to ACD. A bronchial provocation test with DGEBA caused a 36% drop in the peak expiratory flow, reflecting a delayed type of occupational asthma. This bronchial provocation test caused a strong dermatitis of the exposed skin of the face, in accordance with airborne ACD from DGEBA.

Adult↗
PubMed1993

[Bronchial provocation tests. Comparison of 2 inhalation methods].

This study was performed to compare two methods of aerosols delivery and inhalation in a bronchial provocation test with carbachol : the stocked method (S) where the aerosol is previously stocked in a spirometer bell before inhalation and the dosimeter method (D) where the aerosol is directly inhaled after nebulization. Fourteen subjects (seven normal and seven asthmatic) underwent bronchial challenges with the two techniques. Bronchial sensitivity was calculated on SRaw-dose response curves to carbachol. SGaw-dose response curves were also constructed and the slopes of these curves were used to measure bronchial reactivity. Within subjects sensitivity values were lower with the D method than with the S method (40 +/- 5 micrograms (S E) versus 450 +/- 50 micrograms respectively in asthmatics, 340 +/- 30 micrograms versus 2350 +/- 130 micrograms respectively in healthy subjects). Reactivity values were higher with the dosimeter method (2,7 +/- 0,7 x 10(-5) versus 27 +/- 4 x 10(-5) in healthy and 10 +/- 1 x 10(-5) versus 106 +/- 16 x 10(-5) in asthmatics). The dosimeter method had greater efficacy, was less time consuming and appeared to be a useful method for carrying out standardised non-specific bronchoprovocation test.

Adult↗