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PubMed1997

[The specific bronchial provocation test in the diagnosis of occupational asthma].

Specific bronchial challenge (SBC) testing is a key technique for diagnosing the origin of occupational asthma (OA). SBC is indicated in specific circumstances, including whenever several agents present in the work environment may be the cause of OA, when new or unusual occupational agents need to be identified, when evidence for legal action is required, or when research is conducted. SBC procedures are not standardized, because of the great diversity of occupational agents and the variety of physical and chemical properties involved. Thus, SBC testing with agents found in fumes, gases or vapors can be administered in special cabins or in closed circuits with continuous monitoring of sub-irritant concentrations. Agents found in dust, most but not all of which have high molecular weights, may be appropriate for routine SBC testing in an allergy laboratory. This paper will treat only these cases. SBC must be formed in specialized centers by experienced personnel, as it is a sophisticated and potentially dangerous technique. We describe a series of 20 patients diagnosed of OA in our unit over the past two years in whom SBC provided an etiologic diagnosis. All were exposed to dust or aerosols at work. The cause was a substance of high molecular weight in 17 cases, and low molecular weight in 3. The procedure used is described and models of bronchial response are discussed.

Adolescent↗
PubMedDate not supplied

Bronchial provocation tests in etiologic diagnosis of asthma.

UNLABELLED: Several methods of bronchial challenging have been described in literature. The comparison of the results obtained in different departments is, of course, very difficult. The Authors have been interested in the standardization of inhalation challenge techniques and they present in this work their method and the results obtained. The standardized method has a good specificity, because of the agreement between B.P.T. and other diagnostic tests. The bronchial reaction generally developes after the exposition to low doses of allergen extract, and this confirms the specificity of the method. Its precision, depending on the standardization of allergen extract activity by RAST and of inhalation procedures, is good. The reproducibility is of 100 per cent. The safety is high (rare untword reactions). IN CONCLUSION: this standardized method of bronchial challenging is useful in etiologic diagnosis of asthma.

Adult↗
PubMed2000

[Randomized double-blind study (third place blinded) to examine the effectiveness and side effects of methacholine in the nonspecific bronchial provocation test].

Softly and effectiveness of methacholine for the diagnosis of non-specific bronchial hyperresponsiveness [BHR] were tested in a third place blinded study. 61 patients suspected to suffer from BHR took part. 56 subjects provided complete data and were included in the study. 27 participants were challenged with methacholine 0.33% (verum) and 29 patients received NaCl 0.9% (placebo). The challenge was applied as 5-step-test using a storage bag. The doses were elevated by doubling the aerosol volume. A positive test result was assumed when basal specific airway resistance (sRt) reduplicated and simultaneously 2.0 (kPa*s) was attained. Ten out of 27 subjects in the verum group (33.3%) had a positive test result whereas in the placebo group only one subject showed a reaction (3.5%). A statistically significant association between the change of sRt and the cumulative methacholine dose was confirmed in the verum group (p < 0.002), whereas this effect could not be observed in patients challenged with placebo (p = 0.20). Side effects did not occur. We conclude that inhalative challenge with methacholine 0.33% applied as a 5-step-test is suitable to objectify BHR. The substantial benefit of the applied test scheme is the short range of time in which the challenge can be performed (approximately 20 min) and that dilution series of the test substance (methacholine 0.33%) are not required.

Adult↗