Predictors of methacholine challenge testing results in subjects without airflow obstruction

Chevrier, Stephanie; Abdulnour, Joseph; Saint-Pierre, Mathieu

doi:10.1080/02770903.2021.1986838

Cited by 3 publications

(3 citation statements)

References 38 publications

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“…Nickels performed a retrospective chart review of 1322 adults with non-obstructive spirometry results to assess if FeNO testing is predictive of a positive methacholine BCT, which did not reveal any statistically significant findings [ 36 ]. Chevrier conducted a retrospective chart review of 1126 subjects with normal spirometry results who underwent methacholine BCT [ 14 ]. The authors identified younger age, female sex, body mass index (BMI) > 40, and symptoms of wheezing as factors associated with an abnormal BCT of PC 20 < 16 mg/mL.…”

Section: Discussionmentioning

confidence: 99%

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Anticipating undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry: a decision tool for bronchial challenge testing

Shin,

Whitmore,

Boulet

et al. 2023

BMC Pulm Med

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Background Some patients with asthma demonstrate normal spirometry and remain undiagnosed without further testing. Objective To determine clinical predictors of asthma in symptomatic adults with normal spirometry, and to generate a tool to help clinicians decide who should undergo bronchial challenge testing (BCT). Methods Using random-digit dialling and population-based case-finding, we recruited adults from the community with respiratory symptoms and no previous history of diagnosed lung disease. Participants with normal pre- and post-bronchodilator spirometry subsequently underwent BCT. Asthma was diagnosed in those with symptoms and a methacholine provocative concentration (PC20) of < 8 mg/ml. Sputum and blood eosinophils, and exhaled nitric oxide were measured. Univariate analyses identified potentially predictive variables, which were then used to construct a multivariable logistic regression model to predict asthma. Model sensitivity, specificity, and area under the receiver operating curve (AUC) were calculated. Results Of 132 symptomatic individuals with normal spirometry, 34 (26%) had asthma. Of those ultimately diagnosed with asthma, 33 (97%) answered ‘yes’ to a question asking whether they experienced cough, chest tightness or wheezing provoked by exercise or cold air. Other univariate predictors of asthma included female sex, pre-bronchodilator FEV1 percentage predicted, and percent positive change in FEV1 post bronchodilator. A multivariable model containing these predictive variables yielded an AUC of 0.82 (95% CI: 0.72–0.91), a sensitivity of 82%, and a specificity of 66%. The model was used to construct a nomogram to advise clinicians which patients should be prioritized for BCT. Conclusions Four readily available patient characteristics demonstrated a high sensitivity and AUC for predicting undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry. These characteristics can potentially help clinicians to decide which individuals with normal spirometry should be investigated with bronchial challenge testing. However, further prospective validation of our decision tool is required.

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Section: Discussionmentioning

confidence: 99%

“…Recent studies have assessed potential variables associated with BCT results consistent with asthma [ 13 , 14 ]. These studies were limited to retrospective chart analyses and assessment of demographic differences via univariate analyses.…”

Section: Introductionmentioning

confidence: 99%

Anticipating undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry: a decision tool for bronchial challenge testing

Shin,

Whitmore,

Boulet

et al. 2023

BMC Pulm Med

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“…Impaired FEF 25–75 can reflect airway hyperresponsiveness, inflammation, and disease severity more precisely than FEV 1 in asthmatic adults and children [ 7 , 8 , 9 , 10 , 11 ]. Moreover, decreased FEF 25–75 is associated with bronchial reversibility and response to drugs and biologics [ 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Role of FEF25–75 in characterizing outpatients with asthma in clinical practice

Ciprandi,

Schiavetti

2024

ALS

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Background: Asthma is characterized by variable airflow limitation. FEF 25–75 has been proposed as a reliable marker for bronchial obstruction, especially when FEV 1 and FEV 1 /FVC are normal. Objectives: To investigate the role of FEF 25–75 in patients with asthma seen in clinical settings. Materials and methods: The cross-sectional study included 439 (181 females and 255 males; mean age 39 years) outpatients with asthma who consecutively visited an allergy clinic for a routine assessment. History, physical examination, asthma control, and spirometry were evaluated. Results: FEF 25–75 was impaired (< 65% of predicted) in 136 (31%) outpatients. Considering only subjects with normal FEV 1 and FEV 1 /FVC, FEF 25–75 was impaired in 71 (19.6%) subjects. In this subset, impaired FEF 25–75 was associated with low FEV 1 and FEV 1 /FVC values (OR 0.91 and 0.85, respectively), and presence of asthma symptoms (OR 2.19). Conclusion: FEF 25–75 deserves adequate and careful consideration in patients with asthma and normal FEV 1 and FEV 1 /FVC, as the presence of impaired FEF 25–75 in this subset suggests a more specific approach.

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Diagnostic value of lung function tests in long COVID: analysis of positive bronchial provocation test outcomes

Liu,

Feng,

Yuan

et al. 2025

Front. Med.

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BackgroundLong COVID patients are prone to bronchial hyperresponsiveness and respiratory symptoms like coughing and breathing difficulties, often with positive bronchial provocation test (BPT) results.ObjectiveThis study aims to evaluate the diagnostic value of various lung function tests in patients with long-term COVID-19, explicitly focusing on positive BPT outcomes.MethodsOur study analyzed the BPT outcomes and various pulmonary function parameters of all 9,406 COVID-19 patients who met the inclusion criteria and visited our hospital between February 24, 2022, and April 28, 2024. Key indicators included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and single-breath diffusing capacity for carbon monoxide (DLCOc SB). A logistic regression model was employed to identify factors influencing positive BPT results, while the receiver operating characteristic (ROC) curve was used to assess the diagnostic efficacy of these indicators.ResultsA total of 4211 valid samples were analyzed, with 3388 patients (80.46%) testing positive for BPT. Significant differences were observed between positive and negative groups regarding age, gender, smoking status (all P < 0.05), and specific lung function indicators, including FVC, FEV1/FVC ratio, maximum of vital capacity (VC max), and DLCOc SB (all P < 0.001). Logistic regression identified age, MEF50, and DLCOc SB as independent factors influencing positive BPT results. The area under the ROC curve for all assessed factors was <0.700, indicating limited diagnostic value.ConclusionAge, the small airway function indicator MEF50, and the pulmonary diffusion function indicator DLCOc SB are independent influencing factors for BPT positivity in long-term COVID patients. However, baseline data and lung function indicators have limited utility for diagnosing positive BPT in this population, highlighting the complex nature of post-COVID respiratory symptoms.

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Predictors of methacholine challenge testing results in subjects without airflow obstruction

Cited by 3 publications

References 38 publications

Anticipating undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry: a decision tool for bronchial challenge testing

Anticipating undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry: a decision tool for bronchial challenge testing

Role of FEF25–75 in characterizing outpatients with asthma in clinical practice

Diagnostic value of lung function tests in long COVID: analysis of positive bronchial provocation test outcomes

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