Abstract
While methacholine (MCH) testing is commonly used in the clinical diagnosis of asthma, the detection of airway narrowing often relies on either spirometry or body plethysmography, however comparative studies are rare. In this study we performed MCH testing in 37 patients with variable shortness of breath at work and in 37 patients with no history of airway disease. The inclusion criteria were: no acute respiratory infection within 6 weeks, no severe diseases, normal baseline specific airway resistance (sRaw), normal baseline forced expiratory volume in 1 s (FEV1), Tiffeneau index >70%, no previous treatment with steroids within 14 days and no short acting bronchodilators within 24 h. Cumulative doses of 0.003, 0.014, 0.059, 0.239 and 0.959 mg MCH were inhaled by a dosimeter method. A FEV1 decrease of ≥20% from baseline and a 100% increase of sRaw to ≥2.0 kPa/s was defined as end-of-test-criterion. Provocation doses were calculated by interpolation. Performance of lung function parameters was compared using receiver-operating-characteristic (ROC) analysis. ROC analysis resulted in an area under the ROC curve (AUC) of 0.74 for FEV1 vs. 0.82 for sRaw. The corresponding Youden Indices (J) were 0.46 for FEV1 and 0.57 for sRaw. The Youden Index of sRaw was higher and sensitivity and specificity (73%/84%) were rather well-balanced, in contrast to FEV1 (54%/92%). In conclusion, in cumulative MCH challenges sRaw was found to be the overall most useful parameter for the detection of bronchial hyperresponsiveness. Body plethysmography yielded a balanced sensitivity-specificity ratio with higher sensitivity than spirometry, but comparable specificity.
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References
Anderson, S. D., Charlton, B., Weiler, J. M., Nicols, S., Spector, S. L., Pearlman, D. S., & A 305 Study Grroup. (2009). Comparison of mannitol and methacholine to predict exercise-induced bronchoconstriction and a clinical diagnosis of asthma. Respiratory Research, 10, 4.
Baur, X., Nowak, D., Triebig, G., & Schneider, J. (2005). Arbeitsmedizinische Leitlinie der Deutschen Gesellschaft für Arbeitsmedizin und Umweltmedizin eV-Lungenfunktionsprüfungen in der Arbeitsmedizin. Arbeitsmed Sozialmed Umweltmed, 40(6), 358–367.
Cockcroft, D. W., & Berscheid, B. A. (1983). Measurement of responsiveness to inhaled histamine: Comparison of FEV1 and SGaw. Annals of Allergy, 51(3), 374–377.
Cockcroft, D. W., & Davis, B. E. (2006). The bronchoprotective effect of inhaling methacholine by using total lung capacity inspirations has a marked influence on the interpretation of the test result. The Journal of Allergy and Clinical Immunology, 117(6), 1244–1248.
Cockcroft, D. W., Killian, D. N., Mellon, J. J. A., & Hargreave, F. E. (1977). Bronchial reactivity to inhaled histamine: A method and clinical survey. Clinical and Experimental Allergy, 7(3), 235–243.
Cockcroft, D. W., Berscheid, B. A., & Murdock, K. Y. (1983). Unimodal distribution of bronchial responsiveness to inhaled histamine in a random human population. Chest, 83(5), 751–754.
Crapo, R. O., Casaburi, R., Coates, A. L., Enright, P. L., Hankinson, J. L., Irvin, C. G., MacIntyre, N. R., McKay, R. T., Wanger, J. S., Anderson, S. D., Cockcroft, D. W., Fish, J. E., & Sterk, P. (2000). Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. American Journal of Respiratory and Critical Care Medicine, 161(1), 309–329.
Criée, C. P., Sorichter, S., Smith, H. J., Kardos, P., Merget, R., Heise, D., Berdel, D., Köhler, D., Magnussen, H., Marek, W., Mitfessel, H., Rasche, K., Rolke, M., Worth, H., Jörres, R. A., & Working Group for Body Plethysmography of the German Society for Pneumology and Respiratory Care. (2011). Body plethysmography – Its principles and clinical use. Respiratory Medicine, 105(7), 959–971.
Greiner, M., Pfeiffer, D., & Smith, R. D. (2000). Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Preventive Veterinary Medicine, 45(1–2), 23–41.
Hendrick, D. J., Fabbri, L. M., Hughes, J. M., Banks, D. E., Barkman, H. W. Jr., Connolly, M. J., Jones, R. N., & Weill, H. (1986). Modification of the methacholine inhalation test and its epidemiologic use in polyurethane workers. American Review of Respiratory Disease, 133(4), 600–604.
Ihaka, R., & Gentleman, R. (1996). R: A language for data analysis and graphics. Journal of Computational and Graphical Statistics, 5(3), 299–314.
Juniper, E. F., Frith, P. A., & Hargreave, F. E. (1981). Airway responsiveness to histamine and methacholine: Relationship to minimum treatment to control symptoms of asthma. Thorax, 36(8), 575–579.
Khalid, I., Morris, Z. Q., & Digiovine, B. (2009). Specific conductance criteria for a positive methacholine challenge test: Are the American Thoracic Society guidelines rather generous? Respiratory Care, 54(9), 1168–1174.
Lötvall, J., Inman, M., & O’Byrne, P. (1998). Measurement of airway hyperresponsiveness: New considerations. Thorax, 53(5), 419–424.
Merget, R., Jörres, R. A., Heinze, E., Haufs, M. G., Taeger, D., & Brüning, T. (2009). Development of a 1-concentration-4-step dosimeter protocol for methacholine testing. Respiratory Medicine, 103(4), 607–613.
Nadel, J. A., & Tierney, D. F. (1961). Effect of a previous deep inspiration on airway resistance in man. Journal of Applied Physiology, 16, 717–719.
O’Connor, G., Sparrow, D., Taylor, D., Segal, M., & Weiss, S. (1987). Analysis of dose–response curves to methacholine. An approach suitable for population studies. American Review of Respiratory Disease, 136(6), 1412–1417.
Popa, V., & Singleton, J. (1988). Provocation dose and discriminant analysis in histamine bronchoprovocation. Are the current predictive data satisfactory? Chest, 94(3), 466–475.
Schisterman, E. F., Perkins, N. J., Liu, A., & Bondell, H. (2005). Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples. Epidemiology (Cambridge, Mass.), 16(1), 73–81.
Sing, T., Sander, O., Beerenwinkel, N., & Lengauer, T. (2005). ROCR: Visualizing classifier performance in R. Bioinformatics (Oxford, England), 21(20), 3940–3941.
Slats, A. M., Janssen, K., van Schadewijk, A., van der Plas, D. T., Schot, R., van den Aardweg, J. G., de Jongste, J. C., Hiemstra, P. S., Mauad, T., Rabe, K. F., & Sterk P. J. (2007). Bronchial inflammation and airway responses to deep inspiration in asthma and chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 176(2), 121–128.
Sterk, P. J., Fabbri, L. M., Quanjer, P. H., Cockcroft, D. W., O’Byrne, P. M., Anderson, S. D., Juniper, E. F., & Malo, J. L. (1993). Airway responsiveness. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. European Respiratory Journal, 16, 53–83.
Tiffeneau, D. R. (1957). Examen pulmonaire de l’asthmatique, déductions diagnostiques, pronostiques et thérapeutiques, par Robert Tiffeneau (pp. 55–75). Paris: Masson.
van der Lende, R., Visser, B. F., Wever-Hess, J., de Vries, K., & Orie, N. G. (1973). Distribution of histamine threshold values in a random population. Revue de l’Institut D’hygiène Des Mines (Hasselt), 28(4), 186–190.
Woolcock, A. J., Peat, J. K., Salome, C. M., Yan, K., Anderson, S. D., Schoeffel, R. E., McCowage, G., & Killalea, T. (1987). Prevalence of bronchial hyperresponsiveness and asthma in a rural adult population. Thorax, 42(5), 361.
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Nensa, F., Kotschy-Lang, N., Smith, HJ., Marek, W., Merget, R. (2013). Assessment of Airway Hyperresponsiveness: Comparison of Spirometry and Body Plethysmography. In: Pokorski, M. (eds) Respiratory Regulation - Clinical Advances. Advances in Experimental Medicine and Biology, vol 755. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-4546-9_1
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