Comparisons of Peak Diurnal Expiratory Flow Variation, Postbronchodilator FEV1 Responses, and Methacholine Inhalation Challenges in the Evaluation of Suspected Asthma

Goldstein, Michael S.; Veza, Bernadette A.; Dunsky, Eliot H.; Dvorin, Donald J.; Belecanech, George A.; Haralabatos, Irene C.

doi:10.1378/chest.119.4.1001

Cited by 71 publications

(63 citation statements)

References 37 publications

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“…D'Urzo has correctly identified from our data [1] that bronchial challenge testing seems to be a more sensitive test to confirm asthma compared to pre-and post-bronchodilator spirometry. Our results were similar to those of GOLDSTEIN et al [2] who demonstrated that bronchial challenge testing with methacholine has far greater sensitivity to diagnose asthma compared with post-bronchodilator spirometry. Despite these findings, pre-and post-bronchodilator spirometry should probably be the first-line test to diagnose or confirm asthma for several reasons.…”

Section: From the Authorssupporting

confidence: 91%

From the authors:

Aaron¹,

Luks²

2010

Eur Respir J

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Section: From the Authorssupporting

confidence: 91%

From the authors:

Aaron¹,

Luks²

2010

Eur Respir J

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“…It is well known that bronchial hyperresponsiveness can occur in nonasthmatic patients, who might have been included in the present study, such as those with allergic rhinitis, those who have recently had a viral respiratory infection or smokers with normal lung function [15]. However, using a PC20 of f8 mg?mL -1 , the value used in the present study, GOLDSTEIN et al [14] demonstrated a specificity of 100% for the MCT.…”

Section: Discussionmentioning

confidence: 63%

“…The patients in whom asthma was excluded were followed for 6 months; however, it is possible for asthmatics to be symptom-free and show minimal airway inflammation and hyperresponsiveness for an unknown duration of time, especially if their asthma becomes manifest only with particular exposures. In a study of patients with undiagnosed respiratory symptoms possibly consistent with asthma who were followed for 6 months after a MCT, the sensitivity of the MCT, although far superior to either peak expiratory flow variability or postbronchodilator change in FEV1, was still only 86%, allowing for the possibility of false negative results [14]. It is also possible that asthma was falsely confirmed in some patients.…”

Section: Discussionmentioning

confidence: 99%

Confirmation of asthma in an era of overdiagnosis

Luks¹,

Vandemheen²,

Aaron³

2010

Eur Respir J

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It was recently shown that 30% of adults with a physician diagnosis of asthma did not have asthma when objectively assessed using a four-step algorithm involving serial spirometry, bronchial challenge testing and subsequent tapering of asthma medications. The objective of the present study was to determine how many steps in the algorithm were required in order to confirm asthma, and whether any patient-related variables were associated with earlier asthma confirmation.A total of 540 subjects with a previous physician diagnosis of asthma were randomly recruited from the community. The number of subjects confirmed with asthma at each study visit was calculated. Regression analysis was used to determine variables associated with earlier asthma confirmation.Of the 499 subjects who completed the diagnostic algorithm, 346 (69%) had asthma confirmed and 150 (30%) had asthma excluded. Of subjects in whom asthma was confirmed, including those using regular asthma controlling medications, .90% were confirmed with only one or two study visits, by either pre-and post-bronchodilator spirometry or a single bronchial challenge test. Only 46 (9%) out of 499 subjects required tapering of asthma medications and repeated bronchial challenge tests for exclusion or confirmation of asthma. Lower forced expiratory volume in 1 s and younger age were associated with earlier asthma confirmation.For the majority with a previous physician diagnosis of asthma, only pre-and postbronchodilator spirometry and a single methacholine challenge test are required in order to confirm asthma.

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“…Excessive lung function variability, as assessed by peak expiratory flow (PEF), has been suggested to be a useful indicator of bronchial hyperresponsiveness for clinical or epidemiologic purposes (12)(13)(14)(15)(16). However, several studies have failed to identify an index of PEF variability that could be used to distinguish asthmatic persons from others (16,17), and PEF variability is not always significantly correlated with the slope of the dose-response curve of the methacholine challenge.…”

mentioning

confidence: 99%

Methacholine bronchial responsiveness and variations in lung function among workers exposed to flour

Choudat¹,

Bensefa²,

Causse-Sounillac³

et al. 2005

Scand J Work Environ Health

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Objectives Methacholine bronchial responsiveness and variations in the pulmonary function of workers exposed to wheat flour and a reference group were compared.Methods Each subject [140 men exposed to flour (bakers and pastry makers) and 77 controls] completed a standardized questionnaire. Bronchial responsiveness was quantified by measuring the slope between percentage decrements in forced expiratory volume in 1 second (FEV 1 ) and cumulative methacholine dose. FEV 1 and peak expiratory flow (PEF) were recorded four times a day for 15 days using a handheld electronic spirometer. The variability in the FEV 1 and PEF readings was expressed as variation coefficients (100 × standard deviation/mean). ResultsThe mean duration of exposure to flour was 14 (SD 9) years. Rhinitis was significantly more common in the exposed group than in the control group (30.7% versus 11.7%, P=0.001). The mean FEV 1 and PEF did not significantly differ between the two groups. The slope of the dose-response to methacholine and the variation coefficients were lower among the unexposed nonsmokers than among the exposed workers and smokers. The differences were significant for the exposed smokers. The two variation coefficients correlated with each other (r=0.82) but not with the slope of the methacholine challenge.Conclusions Occupational exposure to flour and smoking increase bronchial responsiveness, as measured by the slope of the dose-response to methacholine and the variation coefficients of airflow. However, methacholine bronchial responsiveness and the variability of lung function do not measure exactly the same aspect of airway behavior.

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Comparisons of Peak Diurnal Expiratory Flow Variation, Postbronchodilator FEV1 Responses, and Methacholine Inhalation Challenges in the Evaluation of Suspected Asthma

Cited by 71 publications

References 37 publications

From the authors:

From the authors:

Confirmation of asthma in an era of overdiagnosis

Methacholine bronchial responsiveness and variations in lung function among workers exposed to flour

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