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Bronchial provocation testing does not detect exercise-induced laryngeal obstruction.
J Asthma. 2017 01 02; 54(1):77-83.JA

Abstract

INTRODUCTION

Exercise-induced laryngeal obstruction (EILO) is a key differential diagnosis for asthma in the presence of exertional respiratory symptoms. Continuous laryngoscopy during exercise (CLE), the current gold standard diagnostic test for EILO, has practical limitations. We aimed to establish if inspiratory flow data obtained during standard bronchoprovocation testing, to establish the presence of extra-thoracic hyper-responsiveness, may prove diagnostic for EILO and thus preclude requirement for CLE testing.

METHODS

We consecutively evaluated 37 adult subjects with exertional dyspnea and possible asthma referred over 6 months. All subjects received comprehensive assessment including a detailed clinical evaluation; pulmonary function testing, indirect and direct bronchial provocation testing, and CLE testing.

RESULTS

Out of 37 subjects, moderate or severe EILO was diagnosed in 8 subjects (22%, all female) while 5 (14%) had both asthma and EILO. There was no correlation between degree of EILO during CLE and mean decrease in forced inspiratory flow (%FIF50) obtained during neither the Methacholine (r = -0.15; p = 0.38) nor Mannitol (r = 0.04; p = 0.84) provocation tests.

CONCLUSION

Inspiratory flow parameters obtained during bronchoprovocation tests did not reliably detect EILO. It remains that CLE is an important and key investigation modality in establishing a secure diagnosis of EILO.

Authors+Show Affiliations

a Respiratory Research Unit, Department of Respiratory Medicine , Bispebjerg University Hospital , Copenhagen , Denmark.b Department of Respiratory Medicine , Royal Brompton Hospital , London , United Kingdom.a Respiratory Research Unit, Department of Respiratory Medicine , Bispebjerg University Hospital , Copenhagen , Denmark.a Respiratory Research Unit, Department of Respiratory Medicine , Bispebjerg University Hospital , Copenhagen , Denmark.a Respiratory Research Unit, Department of Respiratory Medicine , Bispebjerg University Hospital , Copenhagen , Denmark.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27285291

Citation

Walsted, Emil Schwarz, et al. "Bronchial Provocation Testing Does Not Detect Exercise-induced Laryngeal Obstruction." The Journal of Asthma : Official Journal of the Association for the Care of Asthma, vol. 54, no. 1, 2017, pp. 77-83.
Walsted ES, Hull JH, Sverrild A, et al. Bronchial provocation testing does not detect exercise-induced laryngeal obstruction. J Asthma. 2017;54(1):77-83.
Walsted, E. S., Hull, J. H., Sverrild, A., Porsbjerg, C., & Backer, V. (2017). Bronchial provocation testing does not detect exercise-induced laryngeal obstruction. The Journal of Asthma : Official Journal of the Association for the Care of Asthma, 54(1), 77-83. https://doi.org/10.1080/02770903.2016.1195843
Walsted ES, et al. Bronchial Provocation Testing Does Not Detect Exercise-induced Laryngeal Obstruction. J Asthma. 2017 01 2;54(1):77-83. PubMed PMID: 27285291.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bronchial provocation testing does not detect exercise-induced laryngeal obstruction. AU - Walsted,Emil Schwarz, AU - Hull,James H, AU - Sverrild,Asger, AU - Porsbjerg,Celeste, AU - Backer,Vibeke, Y1 - 2016/06/10/ PY - 2016/6/11/pubmed PY - 2017/7/18/medline PY - 2016/6/11/entrez KW - Asthma KW - dyspnea KW - exercise KW - laryngoscopy SP - 77 EP - 83 JF - The Journal of asthma : official journal of the Association for the Care of Asthma JO - J Asthma VL - 54 IS - 1 N2 - INTRODUCTION: Exercise-induced laryngeal obstruction (EILO) is a key differential diagnosis for asthma in the presence of exertional respiratory symptoms. Continuous laryngoscopy during exercise (CLE), the current gold standard diagnostic test for EILO, has practical limitations. We aimed to establish if inspiratory flow data obtained during standard bronchoprovocation testing, to establish the presence of extra-thoracic hyper-responsiveness, may prove diagnostic for EILO and thus preclude requirement for CLE testing. METHODS: We consecutively evaluated 37 adult subjects with exertional dyspnea and possible asthma referred over 6 months. All subjects received comprehensive assessment including a detailed clinical evaluation; pulmonary function testing, indirect and direct bronchial provocation testing, and CLE testing. RESULTS: Out of 37 subjects, moderate or severe EILO was diagnosed in 8 subjects (22%, all female) while 5 (14%) had both asthma and EILO. There was no correlation between degree of EILO during CLE and mean decrease in forced inspiratory flow (%FIF50) obtained during neither the Methacholine (r = -0.15; p = 0.38) nor Mannitol (r = 0.04; p = 0.84) provocation tests. CONCLUSION: Inspiratory flow parameters obtained during bronchoprovocation tests did not reliably detect EILO. It remains that CLE is an important and key investigation modality in establishing a secure diagnosis of EILO. SN - 1532-4303 UR - https://www.unboundmedicine.com/medline/citation/27285291/Bronchial_provocation_testing_does_not_detect_exercise_induced_laryngeal_obstruction_ L2 - http://www.tandfonline.com/doi/full/10.1080/02770903.2016.1195843 DB - PRIME DP - Unbound Medicine ER -