Standardizing dose in dosimetric bronchial challenge tests

Abstract

Recent technical recommendations on bronchial challenge testing aim at standardized assessment of provocative dose of causing 20% decrease in FEV1 (PD20). The aim of this study was to investigate the effect of mode of nebulization on the output of a computerized dosimeter (APS) and to compare PD20 obtained by two different dosimetric systems in vivo. The output of the APS system was tested during continuous nebulization, and using simulated breaths, for intermittent actuations with four different durations. Using output data, a modified methacholine challenge protocol was applied for APS and compared with a standard set-up using Spira dosimeter in 14 asthmatic patients attending duplicate methacholine challenges using both systems, within median (range) 3 (1-6) days apart. The calculated output (mg min ) with all the intermittent mode settings was significantly higher (P<0·001) than in the continuous mode, and in the intermittent mode, the output was dependent of the pulse duration. The PD20 values assessed with the APS and Spira systems were significantly correlated (r = 0·69; P<0·007), without systematic difference in the geometric means (P = 0·10). A moderate to good agreement was found for assessment of significant hyperresponsiveness. The results suggest that in dosimetric systems for bronchial challenge tests, the output of the nebulizer is dependent on the mode of nebulization, and this should be considered when standardizing the dose between devices and protocols. As long as the delivered dose is determined for the specified nebulization mode of the protocol, it may be possible to obtain comparable results between different devices.

Measurement of bronchial hyperreactivity: comparison of three Nordic dosimetric methods

“…The five steps are: one inhalation at 2.5 mg/ml, three inhalations at 2.5 mg/ml, 11 inhalations at 2.5 mg/ml, three inhalations at 25 mg/ml and 10 inhalations at 25 mg/ml. The non-cumulated doses inhaled in the five steps are: 0.018, 0.054, 0.198, 0.540 and 1.78 mg, respectively [14]. The time between the steps is 5 min.…”

“…Additionally, it facilitates comparison of epidemiological results. Recent population-based studies and clinical trials utilise one of the aforementioned testing methods each: Sovij€ arvi [30][31][32][33][34][35][36][37], Malmberg [38][39][40][41] or Nieminen [14,[42][43][44]; the reference table may serve the purpose of offering comparisons in these example studies and others, or in future studies. Nowadays, the supply of histamine as a challenge test substance is very limited, therefore, a comparison to other challenge methods was also needed.…”