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Comparison of 4 AM and 4 PM Bronchial Responsiveness to Hypertonic Saline in Asthma

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Abstract

Bronchial responsiveness to methacholine or histamine increases at night and may contribute to the mechanisms of nocturnal asthma. Hypertonic saline (HS) is a more clinically relevant stimulus for the diagnosis and assessment of the severity of asthma, but the circadian variation in bronchial responsiveness to hypertonic challenges has not been addressed. The aim of this study was to compare the responsiveness to hypertonic saline at 4:00 AM and at 4:00 PM. Eighteen diurnally active patients (11 women) with asthma, 31 ± 9 years of age (mean ± SD) and with a forced expiratory volume in 1 s (FEV1) of 79.11% ± 12.85%, underwent two challenge tests (4:00 AM and 4:00 PM) in random sequence separated by an interval of 7 days. The challenge test consisted of inhalations of 4.5% saline with increasing doses by doubling the duration of nebulization (0.5, 1, 2, 4, and 8 min). The inhalation continued until a drop of 20% in FEV1 was achieved or total time of 15.5 min. The provocative dose that caused the 20% drop in FEV1 (PD20) was calculated. Differences were found between 4:00 PM and 4:00 AM values for inhalation times [3.80 ± 3.57 min and 2.19 ± 2.42 min (p = 0.001), respectively] and for PD20 [4.94 ± 6.77 ml and 2.93 ± 4.74 ml (p = 0.002), respectively]. Eight patients with a home-assessed nocturnal peak expiratory flow (PEF) drop of more than 15% formed the nocturnal asthma group. The behavior of these patients was similar to that of the non-nocturnal asthma group. We conclude that the bronchial responsiveness to HS increases at night.

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Abbreviations

HS:

hypertonic saline

FEV1 :

forced expiratory volume in 1 s

PD20 :

provocative dose causing 20% drop in FEV1

PEF:

peak expiratory flow

IQR:

interquartile range

References

  1. American Thoracic Society (1991) Medical section of the American Lung Association. Am Rev Respir Dis 144:1202–1218

    Google Scholar 

  2. American Thoracic Society (2000) Guidelines for methacholine and exercise challenge testing—1999. Am J Respir Crit Care Med 161:309–329

    Google Scholar 

  3. Anderson SD, Brannan JD (2003) Methods for “indirect” challenge tests including exercise, eucapnic voluntary hyperpnea, and hypertonic aerosols. Clin Rev Allergy Immunol 24:27–54

    Article  PubMed  Google Scholar 

  4. Beam WR, Weiner DE, Martin RJ (1992) Timing of prednisone and alterations of airway inflammation in nocturnal asthma. Am Rev Respir Dis 146:1524–1530

    PubMed  CAS  Google Scholar 

  5. Benedito-Silva AA, Menna-Barreto L, Marques N, Tenreiro S (1990) A self-assessment questionnaire for the determination of morningness–eveningness types in Brazil. Prog Clin Biol Res 314:89–98

    Google Scholar 

  6. Bonnet R, Jörres R, Heitmann U, Magnussen H (1991) Circadian rhythm in airway responsiveness and airway tone in patients with mild asthma. J Appl Physiol 71:1598–1605

    PubMed  CAS  Google Scholar 

  7. Cockcroft DW (2001) How best to measure airway responsiveness? Am J Respir Crit Care Med 163:1514–1515

    PubMed  CAS  Google Scholar 

  8. Frezza G, Terra-Filho J, Martinez JAB, Vianna EO (2003) Rapid effect of inhaled steroids on nocturnal worsening of asthma. Thorax 58:632–633

    Article  PubMed  CAS  Google Scholar 

  9. Gibson PG, Henry R, Shah S, et al. (2000) Validation of the ISAAC video questionnaire (AVQ3.0) in adolescents from a mixed ethnic background. Clin Exp Allergy 30:1181–1187

    Article  PubMed  CAS  Google Scholar 

  10. Horne JA, Östberg O (1976) A self-assessment questionnaire to determine morningness–eveningness in human circadian rhythms. Int J Chronobiol 4:97–110

    PubMed  CAS  Google Scholar 

  11. Irwin RS, French CT, Smyrnios NA, Curley FJ (1997) Interpretation of positive results of a methacholine inhalation challenge and 1 week of inhaled bronchodilator use in diagnosis and treating cough-variant asthma. Arch Intern Med 157:1981–1987

    Article  PubMed  CAS  Google Scholar 

  12. Jarjour NN (1999) Circadian variation in allergen and nonspecific bronchial responsiveness in asthma. Chronobiol Int 16:631–639

    PubMed  CAS  Google Scholar 

  13. Joos GF, O’Connor B (2003) Indirect airway challenges. Eur Respir J 21:1050–1068

    Article  PubMed  CAS  Google Scholar 

  14. Kondo S, Abe K (1991) Priority of peak circadian variation of bronchial responsiveness to the trough of circadian variation of bronchial caliber in asthmatic children. Chest 100:640–643

    PubMed  CAS  Google Scholar 

  15. Martin RJ (1999) Location of airway inflammation in asthma and the relationship to circadian change in lung function. Chronobiol Int 16:623–630

    Article  PubMed  CAS  Google Scholar 

  16. Martin RJ, Cicutto LC, Ballard RD (1990) Factors related to the nocturnal worsening of asthma. Am Rev Respir Dis 141:33–38

    PubMed  CAS  Google Scholar 

  17. Martin RJ, Cicutto LC, Smith HR, Ballard RD, Szefler SJ (1991) Airways inflammation in nocturnal asthma? Am Rev Respir Dis 143:351–357

    PubMed  CAS  Google Scholar 

  18. Paggiaro PL (2002) Sputum induction. Eur Respir J 20:3s–8s

    Article  Google Scholar 

  19. Pincus DJ, Szefler SJ, Ackeson LM, Martin RJ (1995) Chronotherapy of asthma with inhaled steroids: the effect of dosage timing on drug efficacy. J Allergy Clin Immunol 95:1172–1178

    Article  PubMed  CAS  Google Scholar 

  20. Pincus DJ, Humeston TR, Martin RJ (1997) Further studies on the chronotherapy of asthma with inhaled steroids: the effect of dosage timing on drug efficacy. J Allergy Clin Immunol 100:771–774

    Article  PubMed  CAS  Google Scholar 

  21. Riedler J, Robertson CF (1994) Effect of tidal volume on the output and particle size distribution of hypertonic saline from an ultrasonic nebulizer. Eur Respir J 7:998–1002

    PubMed  CAS  Google Scholar 

  22. Riedler J, Reade T, Dalton M, Holst D, Robertson C (1994) Hypertonic saline challenge in an epidemiologic survey of asthma in children. Am J Respir Crit Care Med 50:1632–1639

    Google Scholar 

  23. Riedler J, Gamper A, Eder W, Oberfeld G (1998) Prevalence of bronchial hyperresponsiveness to 4.5% saline and its relation to asthma and allergy symptoms in Austrian children. Eur Respir J 11:355–360

    Article  PubMed  CAS  Google Scholar 

  24. Sly PD, Landau LI (1986) Diurnal variation in bronchial responsiveness in children. Pediatr Pulmonol 2:344–352

    PubMed  CAS  Google Scholar 

  25. Smith CM, Anderson SD (1990) Inhalation challenge using hypertonic saline in asthmatic subjects: a comparison with responses to hyperpnoea, methacholine and water. Eur Respir J 3:144–151

    PubMed  CAS  Google Scholar 

  26. Stefano A, Lusuardi M, Braghiroli A, Donner CF (1997) Nocturnal asthma: mechanisms and therapy. Lung 175:53–61

    Article  PubMed  Google Scholar 

  27. Van Schoor J, Joos GF, Pauwels RA (2000) Indirect bronchial hyperresponsiveness in asthma: mechanisms, pharmacology and implications for clinical research. Eur Respir J 16:514–533

    Article  PubMed  Google Scholar 

  28. Vianna EO, Boaventura LC, Terra-Filho J, et al. (2002) Morning-to-evening variation in exercise-induced bronchospasm. J Allergy Clin Immunol 110:236–240

    Article  PubMed  Google Scholar 

  29. Vries K, Goei JT, Booy-Noord H, Orie NGM (1962) Changes during 24 hours in the lung function and histamine hyperreactivity of the bronchial tree in asthmatic and bronchitic patients. Int Arch Allergy Immunol 20:93–101

    Article  Google Scholar 

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Acknowledgments

The authors thank Dr. Sandra Anderson and Dr. Conceição Santos (Royal Prince Alfred Hospital, Australia) for helping us set up the HS challenge procedure. This work was supported by grants 98/10382-6 and 02/12247-6 from the São Paulo State Government (FAPESP), Brazil.

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Authors and Affiliations

  1. Department of Medicine, University of São Paulo Medical School at Ribeirão Preto, Ribeirão Preto, Av. Bandeirantes, 3900, 14048.900, São Paulo, Brazil

    Erica Ferraz, Marcos C. Borges, J. Terra-Filho, José A. B. Martinez & Elcio O. Vianna

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  1. Erica Ferraz
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  2. Marcos C. Borges
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  3. J. Terra-Filho
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  4. José A. B. Martinez
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  5. Elcio O. Vianna
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Correspondence to Elcio O. Vianna.

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Ferraz, E., Borges, M.C., Terra-Filho, J. et al. Comparison of 4 AM and 4 PM Bronchial Responsiveness to Hypertonic Saline in Asthma. Lung 184, 341–346 (2006). https://doi.org/10.1007/s00408-006-0017-0

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  • DOI: https://doi.org/10.1007/s00408-006-0017-0

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