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Diagnostic accuracy of methacholine challenge tests assessing airway hyperreactivity in asthmatic patients - a multifunctional approach.
Respir Res. 2016 11 17; 17(1):154.RR

Abstract

BACKGROUND

There are few studies comparing diagnostic accuracy of different lung function parameters evaluating dose-response characteristics of methacholine (MCH) challenge tests (MCT) as quantitative outcome of airway hyperreactivity (AHR) in asthmatic patients. The aim of this retrospectively analysis of our database (Clinic Barmelweid, Switzerland) was, to assess diagnostic accuracy of several lung function parameters quantitating AHR by dose-response characteristics.

METHODS

Changes in effective specific airway conductance (sGeff) as estimate of the degree of bronchial obstruction were compared with concomitantly measured forced expiratory volume in 1 s (FEV1) and forced expiratory flows at 50% forced vital capacity (FEF50). According to the GINA Guidelines the patients (n = 484) were classified into asthmatic patients (n = 337) and non-asthmatic subjects (n = 147). Whole-body plethysmography (CareFusion, Würzburg, Germany) was performed using ATS-ERS criteria, and for the MCTs a standardised computer controlled protocol with 3 consecutive cumulative provocation doses (PD1: 0.2 mg; PD2: 1.0 mg; PD3: 2.2 mg) was used. Break off criterion for the MCTs were when a decrease in FEV1 of 20% was reached or respiratory symptoms occurred.

RESULTS

In the assessment of AHR, whole-body plethysmography offers in addition to spirometry indices of airways conductance and thoracic lung volumes, which are incorporated in the parameter sGeff, derived from spontaneous tidal breathing. The cumulative percent dose-responses at each provocation step were at the 1st level step (0.2 mg MCH) 3.7 times, at the 2nd level step (1 mg MCH) 2.4 times, and at the 3rd level step (2.2 mg MCH) 2.0 times more pronounced for sGeff, compared to FEV1. A much better diagnostic odds ratio of sGeff (7.855) over FEV1 (6.893) and FEF50 (4.001) could be found. Moreover, the so-called dysanapsis, and changes of end-expiratory lung volume were found to be important determinants of AHR.

CONCLUSIONS

Applying plethysmographic tidal breathing analysis in addition to spirometry in MCTs provides relevant advantages. The absence of deep and maximal inhalations and forced expiratory manoeuvres improve the subject's cooperation and coordination, and provide sensitive and differentiated test results, improving diagnostic accuracy. Moreover, by the combined assessment, pulmonary hyperinflation and dysanapsis can be respected in the differentiation between "asthmatics" and "non-asthmatics".

Authors+Show Affiliations

Department of Clinical Research, University of Berne, Kirchenfeldstrasse 74, CH-3005, Berne, Switzerland. richard.kraemer@swissonline.ch.Medical Development, Research in Respiratory Diagnostics, Berlin, Germany.Division of Pulmonary Medicine, Clinic Barmelweid, CH-5017, Barmelweid, Switzerland.Division of Pulmonary Medicine, Clinic Barmelweid, CH-5017, Barmelweid, Switzerland.Division of Pulmonary Medicine, Clinic Barmelweid, CH-5017, Barmelweid, Switzerland.Division of Pulmonary Medicine, Clinic Barmelweid, CH-5017, Barmelweid, Switzerland.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27855687

Citation

Kraemer, Richard, et al. "Diagnostic Accuracy of Methacholine Challenge Tests Assessing Airway Hyperreactivity in Asthmatic Patients - a Multifunctional Approach." Respiratory Research, vol. 17, no. 1, 2016, p. 154.
Kraemer R, Smith HJ, Sigrist T, et al. Diagnostic accuracy of methacholine challenge tests assessing airway hyperreactivity in asthmatic patients - a multifunctional approach. Respir Res. 2016;17(1):154.
Kraemer, R., Smith, H. J., Sigrist, T., Giger, G., Keller, R., & Frey, M. (2016). Diagnostic accuracy of methacholine challenge tests assessing airway hyperreactivity in asthmatic patients - a multifunctional approach. Respiratory Research, 17(1), 154.
Kraemer R, et al. Diagnostic Accuracy of Methacholine Challenge Tests Assessing Airway Hyperreactivity in Asthmatic Patients - a Multifunctional Approach. Respir Res. 2016 11 17;17(1):154. PubMed PMID: 27855687.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic accuracy of methacholine challenge tests assessing airway hyperreactivity in asthmatic patients - a multifunctional approach. AU - Kraemer,Richard, AU - Smith,Hans-Jürgen, AU - Sigrist,Thomas, AU - Giger,Gabi, AU - Keller,Roland, AU - Frey,Martin, Y1 - 2016/11/17/ PY - 2016/08/16/received PY - 2016/11/04/accepted PY - 2016/11/19/entrez PY - 2016/11/20/pubmed PY - 2017/12/5/medline KW - (1) Airway hyperreactivity KW - (2) Bronchial asthma KW - (3) Methacholine challenge test KW - (4) Whole-body plethysmography KW - (5) Effective, specific airway conductance KW - (6) Diagnostic accuracy KW - (7) Dysanapsis SP - 154 EP - 154 JF - Respiratory research JO - Respir. Res. VL - 17 IS - 1 N2 - BACKGROUND: There are few studies comparing diagnostic accuracy of different lung function parameters evaluating dose-response characteristics of methacholine (MCH) challenge tests (MCT) as quantitative outcome of airway hyperreactivity (AHR) in asthmatic patients. The aim of this retrospectively analysis of our database (Clinic Barmelweid, Switzerland) was, to assess diagnostic accuracy of several lung function parameters quantitating AHR by dose-response characteristics. METHODS: Changes in effective specific airway conductance (sGeff) as estimate of the degree of bronchial obstruction were compared with concomitantly measured forced expiratory volume in 1 s (FEV1) and forced expiratory flows at 50% forced vital capacity (FEF50). According to the GINA Guidelines the patients (n = 484) were classified into asthmatic patients (n = 337) and non-asthmatic subjects (n = 147). Whole-body plethysmography (CareFusion, Würzburg, Germany) was performed using ATS-ERS criteria, and for the MCTs a standardised computer controlled protocol with 3 consecutive cumulative provocation doses (PD1: 0.2 mg; PD2: 1.0 mg; PD3: 2.2 mg) was used. Break off criterion for the MCTs were when a decrease in FEV1 of 20% was reached or respiratory symptoms occurred. RESULTS: In the assessment of AHR, whole-body plethysmography offers in addition to spirometry indices of airways conductance and thoracic lung volumes, which are incorporated in the parameter sGeff, derived from spontaneous tidal breathing. The cumulative percent dose-responses at each provocation step were at the 1st level step (0.2 mg MCH) 3.7 times, at the 2nd level step (1 mg MCH) 2.4 times, and at the 3rd level step (2.2 mg MCH) 2.0 times more pronounced for sGeff, compared to FEV1. A much better diagnostic odds ratio of sGeff (7.855) over FEV1 (6.893) and FEF50 (4.001) could be found. Moreover, the so-called dysanapsis, and changes of end-expiratory lung volume were found to be important determinants of AHR. CONCLUSIONS: Applying plethysmographic tidal breathing analysis in addition to spirometry in MCTs provides relevant advantages. The absence of deep and maximal inhalations and forced expiratory manoeuvres improve the subject's cooperation and coordination, and provide sensitive and differentiated test results, improving diagnostic accuracy. Moreover, by the combined assessment, pulmonary hyperinflation and dysanapsis can be respected in the differentiation between "asthmatics" and "non-asthmatics". SN - 1465-993X UR - https://www.unboundmedicine.com/medline/citation/27855687/Diagnostic_accuracy_of_methacholine_challenge_tests_assessing_airway_hyperreactivity_in_asthmatic_patients___a_multifunctional_approach_ L2 - https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-016-0470-0 DB - PRIME DP - Unbound Medicine ER -