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Bronchoprovocative Tests: Clinical Usefulness and Limitations

Bronchoprovocative Tests: Clinical Usefulness and Limitations Abstract Bronchial asthma is easily diagnosed if reversible bronchoconstriction can be demonstrated spirometrically. It becomes difficult if spirometric results are normal and the patient has intermittent coughing, dyspnea, or wheezing. The first induction of an asthma attack in the office was done in 1947 by Curry,1 who conducted challenges with methacholine (acetyl-β-methylcholine) and histamine in healthy persons and subjects with hay fever and asthma. However, bronchial hyperreactivity has only recently been included in the definition of asthma.2,3 The issue becomes more complicated, as recent studies of large populations have shown that bronchial hyperreactivity is not limited to asthma. Close relatives of probands with asthma—and even healthy persons with no family history of atopy or asthma—may demonstrate some degree of bronchial hyperreactivity.2-7 See also p 938. Various means of inducing bronchial hyperreactivity have been developed and can be separated into pharmacologic, allergen, and natural challenges. Methacholine, histamine, acetylcholine, carbachol, References 1. Curry JJ: Comparative action of acetyl-beta-methylcholine and histamine on the respiratory tract in normals, patients with hayfever and subjects with bronchial asthma. J Clin Invest 1947;26:430-435.Crossref 2. Reed C, Townley R: Asthma: Classification and pathogenesis , in Middleton E Jr, Reed CE, Ellis EF (eds): Allergy: Principles and Practice , ed 2. St Louis, CV Mosby Co, 1983, 811-832. 3. Rosenthal RR, Chai H, Mathison DA, et al: Indications for inhalation challenge. J Allergy Clin Immunol 1979;64:603-605.Crossref 4. Townley RG, Bewtra AK, Nair NM, et al: Methacholine inhalation challenge studies. J Allergy Clin Immunol 1979;64:569-574.Crossref 5. Cockcroft DW, Killian DN, Mellon JA, et al: Bronchial reactivity to inhaled histamine: A method and clinical survey. Clin Allergy 1977;7:235-243.Crossref 6. Chatham M, Bleeker ER, Smith PL, et al: A comparison of histamine, methacholine and exercise airway reactivity in normal and asthmatic subjects. Am Rev Respir Dis 1982;126:235-240. 7. Spector SL (ed): Provocative Challenge Procedures: Bronchial, Oral, Nasal and Exercise . Boca Raton, Fla, CRC Press, 1983. 8. Hargreave FE (ed): Airway Reactivity . Mississauga, Ontario, Astra Pharmaceuticals Canada, Ltd, 1980. 9. Griffin M, Weiss W, Leitch AG, et al: Effects of leukotriene D on the airways in asthma. N Engl J Med 1983;308:436-438.Crossref 10. Eggleston PA: Exercise challenge: Indications, techniques and data analysis. J Allergy Clin Immunol 1979;64:604-645.Crossref 11. Strauss RH, McFadden ER Jr, Ingram RH Jr, et al: Enhancement of exercise-induced asthma by cold air. N Engl J Med 1977;297:743-747.Crossref 12. Anderson SD, Schoeffel RE, Finney M: Evaluation of ultrasonically nebulized solutions for provocation testing in patients with asthma. Thorax 1983;38:284-291.Crossref 13. Fetters LJ, Matthews JI: Metacholine challenge test. Arch Intern Med 1984;144:938-940.Crossref 14. Rubinfeld AR, Pain MCF: Relationship between bronchial reactivity airway caliber and severity of asthma. Am Rev Respir Dis 1977;115:381-387. 15. Rebuck AS: Methacholine and airway reactivity. Chest 1982;82:1-2.Crossref 16. Cropp GJA, Bernstein IL, Boushey HA Jr, et al: Guidelines for bronchial inhalation challenges with pharmacologic and antigenic agents. Am Thorac Soc News , (Spring) 1980, pp 11-19. 17. Chai H, Farr RS, Froehlich LA, et al: Standardization of bronchial inhalation challenge procedures. J Allergy Clin Immunol 1975;56:323-327.Crossref 18. Hargreave FE (ed): Methods of Evaluating Airway Reactivity . Mississauga, Ontario, Astra Pharmaceuticals Canada, Ltd, in press. 19. Chatham M, Bleeker ER, Norman P, et al: A screening test for airways reactivity: An abbreviated methacholine inhalation challenge. Chest 1982;82:15-18.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Bronchoprovocative Tests: Clinical Usefulness and Limitations

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Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1984.00350170061008
Publisher site
See Article on Publisher Site

Abstract

Abstract Bronchial asthma is easily diagnosed if reversible bronchoconstriction can be demonstrated spirometrically. It becomes difficult if spirometric results are normal and the patient has intermittent coughing, dyspnea, or wheezing. The first induction of an asthma attack in the office was done in 1947 by Curry,1 who conducted challenges with methacholine (acetyl-β-methylcholine) and histamine in healthy persons and subjects with hay fever and asthma. However, bronchial hyperreactivity has only recently been included in the definition of asthma.2,3 The issue becomes more complicated, as recent studies of large populations have shown that bronchial hyperreactivity is not limited to asthma. Close relatives of probands with asthma—and even healthy persons with no family history of atopy or asthma—may demonstrate some degree of bronchial hyperreactivity.2-7 See also p 938. Various means of inducing bronchial hyperreactivity have been developed and can be separated into pharmacologic, allergen, and natural challenges. Methacholine, histamine, acetylcholine, carbachol, References 1. Curry JJ: Comparative action of acetyl-beta-methylcholine and histamine on the respiratory tract in normals, patients with hayfever and subjects with bronchial asthma. J Clin Invest 1947;26:430-435.Crossref 2. Reed C, Townley R: Asthma: Classification and pathogenesis , in Middleton E Jr, Reed CE, Ellis EF (eds): Allergy: Principles and Practice , ed 2. St Louis, CV Mosby Co, 1983, 811-832. 3. Rosenthal RR, Chai H, Mathison DA, et al: Indications for inhalation challenge. J Allergy Clin Immunol 1979;64:603-605.Crossref 4. Townley RG, Bewtra AK, Nair NM, et al: Methacholine inhalation challenge studies. J Allergy Clin Immunol 1979;64:569-574.Crossref 5. Cockcroft DW, Killian DN, Mellon JA, et al: Bronchial reactivity to inhaled histamine: A method and clinical survey. Clin Allergy 1977;7:235-243.Crossref 6. Chatham M, Bleeker ER, Smith PL, et al: A comparison of histamine, methacholine and exercise airway reactivity in normal and asthmatic subjects. Am Rev Respir Dis 1982;126:235-240. 7. Spector SL (ed): Provocative Challenge Procedures: Bronchial, Oral, Nasal and Exercise . Boca Raton, Fla, CRC Press, 1983. 8. Hargreave FE (ed): Airway Reactivity . Mississauga, Ontario, Astra Pharmaceuticals Canada, Ltd, 1980. 9. Griffin M, Weiss W, Leitch AG, et al: Effects of leukotriene D on the airways in asthma. N Engl J Med 1983;308:436-438.Crossref 10. Eggleston PA: Exercise challenge: Indications, techniques and data analysis. J Allergy Clin Immunol 1979;64:604-645.Crossref 11. Strauss RH, McFadden ER Jr, Ingram RH Jr, et al: Enhancement of exercise-induced asthma by cold air. N Engl J Med 1977;297:743-747.Crossref 12. Anderson SD, Schoeffel RE, Finney M: Evaluation of ultrasonically nebulized solutions for provocation testing in patients with asthma. Thorax 1983;38:284-291.Crossref 13. Fetters LJ, Matthews JI: Metacholine challenge test. Arch Intern Med 1984;144:938-940.Crossref 14. Rubinfeld AR, Pain MCF: Relationship between bronchial reactivity airway caliber and severity of asthma. Am Rev Respir Dis 1977;115:381-387. 15. Rebuck AS: Methacholine and airway reactivity. Chest 1982;82:1-2.Crossref 16. Cropp GJA, Bernstein IL, Boushey HA Jr, et al: Guidelines for bronchial inhalation challenges with pharmacologic and antigenic agents. Am Thorac Soc News , (Spring) 1980, pp 11-19. 17. Chai H, Farr RS, Froehlich LA, et al: Standardization of bronchial inhalation challenge procedures. J Allergy Clin Immunol 1975;56:323-327.Crossref 18. Hargreave FE (ed): Methods of Evaluating Airway Reactivity . Mississauga, Ontario, Astra Pharmaceuticals Canada, Ltd, in press. 19. Chatham M, Bleeker ER, Norman P, et al: A screening test for airways reactivity: An abbreviated methacholine inhalation challenge. Chest 1982;82:15-18.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1984

References