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Airway Dysfunction, Challenge Testing and Occupational Asthma

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Part of the book series: In Clinical Practice ((ICP))

Abstract

Testing for airways dysfunction is a crucial part of pulmonary function testing. In this chapter we review the classification of reactive airways disease as well as the variety of challenge testing available to us. This variation reflects the heterogeneity of patient manifestation of airways dysfunction. We include testing for asthma, occupational airways disease, and exercise induced bronchoconstriction.

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References

  1. Price OJ, Ansley L, Menzies-Gow a, Cullinan P, Hull JH. Airway dysfunction in elite athletes—an occupational lung disease? Allergy Eur J Allergy Clin Immunol. 2013;68:1343–52.

    Article  CAS  Google Scholar 

  2. Parsons JP, Hallstrand TS, Mastronarde JG, et al. An Official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am J Respir Crit Care Med. 2013;187:1016–27.

    Article  CAS  PubMed  Google Scholar 

  3. Crapo RO, Casaburi R, Coates AL, et al. Guidelines for methacholine and exercise challenge testing-1999. Official statement of the American Thoracic Society. Am J Respir Crit Care Med. 2000;161:309–29.

    Article  CAS  PubMed  Google Scholar 

  4. Cockcroft DW, Davis BE, Todd DC, Smycniuk AJ. Methacholine challenge: comparison of two methods. Chest. 2005;127:839–44.

    Article  CAS  PubMed  Google Scholar 

  5. Dell SD, Bola SS, Foty RG, Marshall LC, Nelligan KA, Coates AL. Provocative dose of methacholine causing a 20% drop in FEV1 should be used to interpret methacholine challenge tests with modern nebulizers. Ann Am Thorac Soc. 2015;12:357–63.

    Article  PubMed  Google Scholar 

  6. Coates AL, Wanger J, Cockcroft DW, et al. ERS technical standard on bronchial challenge testing: general considerations and performance of methacholine challenge tests. Eur Respir J. 2017;49:1–17.

    Article  Google Scholar 

  7. Greenspon LW, Morrissey WL. Factors that contribute to inhibition of methacholine-induced bronchoconstriction. Am Rev Respir Dis. 1986;133:735–9.

    CAS  PubMed  Google Scholar 

  8. Ahrens RC, Bonham AC, Maxwell GA, Weinberger MM. A method for comparing the peak intensity and duration of action of aerosolized bronchodilators using bronchoprovocation with methacholine. Am Rev Respir Dis. 1984;129:903–6.

    CAS  PubMed  Google Scholar 

  9. Crimi N, Palermo F, Oliveri R, Polosa R, Settinieri I, Mistretta A. Protective effects of inhaled ipratropium bromide on bronchoconstriction induced by adenosine and methacholine in asthma. Eur Respir J. 1992;5:560–5.

    CAS  PubMed  Google Scholar 

  10. Wilson NM, Green S, Coe C, Barnes PJ. Duration of protection by oxitropium bromide against cholinergic challenge. Eur J Respir Dis. 1987;71:455–8.

    CAS  PubMed  Google Scholar 

  11. Rabe KF, Jörres R, Nowak D, Behr N, Magnussen H. Comparison of the effects of salmeterol and formoterol on airway tone and responsiveness over 24 hours in bronchial asthma. Am Rev Respir Dis. 1993;147:1436–41.

    Article  CAS  PubMed  Google Scholar 

  12. Cockcroft DW, Swystun VA, Bhagat R. Interaction of inhaled beta 2 agonist and inhaled corticosteroid on airway responsiveness to allergen and methacholine. Am J Respir Crit Care Med. 1995;152:1485–9.

    Article  CAS  PubMed  Google Scholar 

  13. Derom EY, Pauwels RA, Van der Straeten ME. The effect of inhaled salmeterol on methacholine responsiveness in subjects with asthma up to 12 hours. J Allergy Clin Immunol. 1992;89:811–5.

    Article  CAS  PubMed  Google Scholar 

  14. McWilliams BC, Menendez R, Kelly HW, Howick J. Effects of theophylline on inhaled methacholine and histamine in asthmatic children. Am Rev Respir Dis. 1984;130:193–7.

    CAS  PubMed  Google Scholar 

  15. Magnussen H, Reuss G, Jörres R. Theophylline has a dose-related effect on the airway response to inhaled histamine and methacholine in asthmatics. Am Rev Respir Dis. 1987;136:1163–7.

    Article  CAS  PubMed  Google Scholar 

  16. Henderson JC, O’Connell F, Fuller RW. Decrease of histamine induced bronchoconstriction by caffeine in mild asthma. Thorax. 1993;48:824–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Prieto L, Bertó JM, Gutiérrez V, Tornero C. Effect of inhaled budesonide on seasonal changes in sensitivity and maximal response to methacholine in pollen-sensitive asthmatic subjects. Eur Respir J. 1994;7:1845–51.

    Article  CAS  PubMed  Google Scholar 

  18. Shapiro GG, Simon RA, Sinon RA. Bronchoprovocation committee report. American Academy of allergy and immunology. J Allergy Clin Immunol. 1992;89:775–8.

    Article  CAS  PubMed  Google Scholar 

  19. Martin RJ, Wanger JS, Irvin CG, Bucher Bartelson B, Cherniack RM. Methacholine challenge testing: safety of low starting FEV1. Asthma Clinical Research Network (ACRN). Chest. 1997;112:53–6.

    Article  CAS  PubMed  Google Scholar 

  20. Tashkin DP, Altose MD, Bleecker ER, Connett JE, Kanner RE, Lee WW, Wise R. The lung health study: airway responsiveness to inhaled methacholine in smokers with mild to moderate airflow limitation. The Lung Health Study Research Group. Am Rev Respir Dis. 1992;145:301–10.

    Article  CAS  PubMed  Google Scholar 

  21. Scott GC, Braun SR. A survey of the current use and methods of analysis of bronchoprovocational challenges. Chest. 1991;100:322–8.

    Article  CAS  PubMed  Google Scholar 

  22. Rijcken B, Schouten JP, Weiss ST, Speizer FE, van der Lende R. The relationship between airway responsiveness to histamine and pulmonary function level in a random population sample. Am Rev Respir Dis. 1988;137:826–32.

    Article  CAS  PubMed  Google Scholar 

  23. Bakke PS, Baste V, Gulsvik A. Bronchial responsiveness in a Norwegian community. Am Rev Respir Dis. 1991;143:317–22.

    Article  CAS  PubMed  Google Scholar 

  24. Peat JK, Salome CM, Xuan W. On adjusting measurements of airway responsiveness for lung size and airway caliber. Am J Respir Crit Care Med. 1996;154:870–5.

    Article  CAS  PubMed  Google Scholar 

  25. Weiss ST, Tager IB, Weiss JW, Munoz A, Speizer FE, Ingram RH. Airways responsiveness in a population sample of adults and children. Am Rev Respir Dis. 1984;129:898–902.

    CAS  PubMed  Google Scholar 

  26. Juniper EF, Cockcroft DW, Hargreave FE. Tidal breathing method. In: Juniper EF, Cockcroft DW, Hargreave FE, editors. Histamine and methacholine inhalation tests: laboratory procedure and standardization. 2nd ed. Lund: Astra Draco AB; 1994.

    Google Scholar 

  27. Cockcroft DW, Killian DN, Mellon JJ, Hargreave FE. Bronchial reactivity to inhaled histamine: a method and clinical survey. Clin Allergy. 1977;7:235–43.

    Article  CAS  PubMed  Google Scholar 

  28. Toelle BG, Peat JK, Salome CM, Crane J, McMillan D, Dermand J, D’Souza W, Woolcock AJ. Comparison of two epidemiological protocols for measuring airway responsiveness and allergic sensitivity in adults. Eur Respir J. 1994;7:1798–804.

    Article  CAS  PubMed  Google Scholar 

  29. Ryan G, Dolovich MB, Roberts RS, Frith PA, Juniper EF, Hargreave FE, Newhouse MT. Standardization of inhalation provocation tests: two techniques of aerosol generation and inhalation compared. Am Rev Respir Dis. 1981;123:195–9.

    CAS  PubMed  Google Scholar 

  30. Beaupré AMJ. Comparison of histamine bronchial challenges with the Wright nebulizer and the dosimeter. Clin Allergy. 1979;9:575–83.

    Article  PubMed  Google Scholar 

  31. Britton J, Mortagy A, Tattersfield A. Histamine challenge testing: comparison of three methods. Thorax. 1986;41:128–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Knox AJ, Wisniewski A, Cooper S, Tattersfield AE. A comparison of the Yan and a dosimeter method for methacholine challenge in experienced and inexperienced subjects. Eur Respir J. 1991;4:497–502.

    CAS  PubMed  Google Scholar 

  33. Peat JK, Salome CM, Bauman A, Toelle BG, Wachinger SL, Woolcock AJ. Repeatability of histamine bronchial challenge and comparability with methacholine bronchial challenge in a population of Australian schoolchildren. Am Rev Respir Dis. 1991;144:338–43.

    Article  CAS  PubMed  Google Scholar 

  34. Bennett JB, Davies RJ. A comparison of histamine and methacholine bronchial challenges using the DeVilbiss 646 nebulizer and the Rosenthal-French dosimeter. Br J Dis Chest. 1987;81:252–9.

    Article  CAS  PubMed  Google Scholar 

  35. Lundgren R, Söderberg M, Rosenhall L, Norrman E. Development of increased airway responsiveness in two nurses performing methacholine and histamine challenge tests. Allergy. 1992;47:188–9.

    Article  CAS  PubMed  Google Scholar 

  36. Todd DC, Davis BE, Hurst TS, Cockcroft DW. Dosimeter methacholine challenge: comparison of maximal versus submaximal inhalations. J Allergy Clin Immunol. 2004;114:517–9.

    Article  CAS  PubMed  Google Scholar 

  37. Allen ND, Davis BE, Hurst TS, Donald W. Difference between dosimeter and tidal breathing methacholine challenge. Chest J. 2005;128:4018–23.

    Article  Google Scholar 

  38. Sterk PJ, Fabbri LM, Quanjer PH, Cockcroft DW, O’Byrne PM, Anderson SD, Juniper EF, Malo JL. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Eur Respir J. 1993;6 Suppl 16:53–83.

    Article  CAS  PubMed  Google Scholar 

  39. Gilbert R, Auchincloss JH. Post-test probability of asthma following methacholine challenge. Chest. 1990;97:562–5.

    Article  CAS  PubMed  Google Scholar 

  40. Cockcroft DW, Murdock KY, Berscheid BA, Gore BP. Sensitivity and specificity of histamine PC20 determination in a random selection of young college students. J Allergy Clin Immunol. 1992;89:23–30.

    Article  CAS  PubMed  Google Scholar 

  41. Ramsdell JW, Nachtwey FJ, Moser KM. Bronchial hyperreactivity in chronic obstructive bronchitis. Am Rev Respir Dis. 1982;126:829–32.

    CAS  PubMed  Google Scholar 

  42. Du Toit JI, Woolcock AJ, Salome CM, Sundrum R, Black JL. Characteristics of bronchial hyperresponsiveness in smokers with chronic air-flow limitation. Am Rev Respir Dis. 1986;134:498–501.

    PubMed  Google Scholar 

  43. Yan K, Salome CM, Woolcock AJ. Prevalence and nature of bronchial hyperresponsiveness in subjects with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1985;132:25–9.

    CAS  PubMed  Google Scholar 

  44. Cheung D, Dick EC, Timmers MC, de Klerk EP, Spaan WJ, Sterk PJ. Rhinovirus inhalation causes long-lasting excessive airway narrowing in response to methacholine in asthmatic subjects in vivo. Am J Respir Crit Care Med. 1995;152:1490–6.

    Article  CAS  PubMed  Google Scholar 

  45. Little JW, Hall WJ, Douglas RG, Mudholkar GS, Speers DM, Patel K. Airway hyperreactivity and peripheral airway dysfunction in influenza A infection. Am Rev Respir Dis. 1978;118:295–303.

    CAS  PubMed  Google Scholar 

  46. Annesi I, Oryszczyn MP, Neukirch F, Orvoen-Frija E, Korobaeff M, Kauffmann F. Relationship of upper airways disorders to FEV1 and bronchial hyperresponsiveness in an epidemiological study. Eur Respir J. 1992;5:1104–10.

    CAS  PubMed  Google Scholar 

  47. Prieto JL, Gutiérrez V, Bertó JM, Camps B. Sensitivity and maximal response to methacholine in perennial and seasonal allergic rhinitis. Clin Exp Allergy. 1996;26:61–7.

    Article  CAS  PubMed  Google Scholar 

  48. Ansley L, Rae G, Hull JH. Practical approach to exercise-induced bronchoconstriction in athletes. Prim Care Respir J. 2013;22:122–5.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Price OJ, Hull JH, Backer V, Hostrup M, Ansley L. The impact of exercise-induced bronchoconstriction on athletic performance: a systematic review. Sport Med. 2014;44:1749–61.

    Article  Google Scholar 

  50. Hull JH, Hull PJ, Parsons JP, Dickinson JW, Ansley L. Approach to the diagnosis and management of suspected exercise-induced bronchoconstriction by primary care physicians. BMC Pulm Med. 2009;9:29.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Carlsen K-H. Sports in extreme conditions: the impact of exercise in cold temperatures on asthma and bronchial hyper-responsiveness in athletes. Br J Sports Med. 2012;46:796–9.

    Article  PubMed  Google Scholar 

  52. Dickinson JW, Whyte GP, McConnell a K, Harries MG. Screening elite winter athletes for exercise induced asthma: a comparison of three challenge methods. Br J Sports Med. 2006;40:179–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Hull JHK, Ansley L, Garrod R, Dickinson JW. Exercise-induced bronchoconstriction in athletes—should we screen? Med Sci Sports Exerc. 2007;39:2117–24.

    Article  PubMed  Google Scholar 

  54. Shephard RJ. Misdiagnosis of exercise-induced bronchoconstriction in professional soccer players. Yearb Sport Med. 2012;2012:268–70.

    Article  Google Scholar 

  55. Price OJ, Ansley L, Hull JH. Diagnosing exercise-induced bronchoconstriction with Eucapnic voluntary hyperpnea: is one test enough? J Allergy Clin Immunol Pract. 2015;3:243–9.

    Article  PubMed  Google Scholar 

  56. Boulet L-P, O’Byrne PM. Asthma and exercise-induced bronchoconstriction in athletes. N Engl J Med. 2015;372:641–8.

    Article  PubMed  Google Scholar 

  57. Eliasson LWAH, Ec C, Phillips LWYY, Rajagopal LKR, Howard RS. Sensitivityand specificity of bronchial ProvocationTesting—an evaluation of four techniques in exercise induced bronchospasm. Chest J. 1992;102:347–55.

    Article  CAS  Google Scholar 

  58. Argyros GJ, Roach JM, Hurwitz KM, Eliasson AH, Phillips YY. Eucapnic voluntary hyperventilation as a bronchoprovocation technique: development of a standardized dosing schedule in asthmatics. Chest J. 1996;105:667–72.

    Google Scholar 

  59. Fishwick D, Barber CM, Bradshaw LM, et al. Standards of care for occupational asthma: an update. Thorax. 2012;67:278–80. https://doi.org/10.1136/thoraxjnl-2011-200755.

    Article  PubMed  Google Scholar 

  60. Tarlo SM. Diagnosis and management of work-related asthma. Chest J. 2008;134:1S.

    Article  CAS  Google Scholar 

  61. Price OJ, Hull JH, Ansley L. Advances in the diagnosis of exercise-induced bronchoconstriction. Expert Rev Respir Med. 2014;8:209–20.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Ali Altalag .

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Altalag, A., Road, J., Wilcox, P., Aboulhosn, K. (2019). Airway Dysfunction, Challenge Testing and Occupational Asthma. In: Altalag, A., Road, J., Wilcox, P., Aboulhosn, K. (eds) Pulmonary Function Tests in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-93650-5_4

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  • DOI: https://doi.org/10.1007/978-3-319-93650-5_4

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