Indirect airway challenges
| Autor: | Jan Lötvall, G DiMaria, Sandra D. Anderson, Guy Joos, H. Magnussen, Mark D. Inman, Ers Task Force, R Polosa, Stephen T. Holgate, J Riedler, B. Dahlén, Dirkje S. Postma, F. E. Hargreave, Donald W. Cockcroft, Frances Chung, Brian P. O'Connor, A Foresi |
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| Rok vydání: | 2003 |
| Předmět: |
Pulmonary and Respiratory Medicine
Respiratory System Population BRADYKININ-INDUCED BRONCHOCONSTRICTION ADENOSINE-INDUCED BRONCHOCONSTRICTION OBSTRUCTIVE PULMONARY-DISEASE Bronchial Provocation Tests Physical Stimulation NEBULIZED DISTILLED WATER Humans Medicine HYPERTONIC SALINE CHALLENGE Practice Patterns Physicians' education Asthma METABISULFITE-INDUCED BRONCHOCONSTRICTION education.field_of_study Exercise-induced asthma METHACHOLINE-INDUCED BRONCHOCONSTRICTION LONG-TERM TREATMENT business.industry Reproducibility of Results respiratory system medicine.disease Stimulation Chemical Respiratory Function Tests respiratory tract diseases Hypertonic saline Scuba diving LEUKOTRIENE-RECEPTOR ANTAGONIST Bronchial hyperresponsiveness Anesthesia Immunology EXERCISE-INDUCED ASTHMA Bronchoconstriction medicine.symptom business Airway |
| Zdroj: | European Respiratory Journal. 21:1050-1068 |
| ISSN: | 1399-3003 0903-1936 |
| Popis: | Indirect challenges act by causing the release of endogenous mediators that cause the airway smooth muscle to contract. This is in contrast to the direct challenges where agonists such as methacholine or histamine cause airflow limitation predominantly via a direct effect on airway smooth muscle. Direct airway challenges have been used widely and are well standardised. They are highly sensitive, but not specific to asthma and can be used to exclude current asthma in a clinic population. Indirect bronchial stimuli, in particular exercise, hyperventilation, hypertonic aerosols, as well as adenosine, may reflect more directly the ongoing airway inflammation and are therefore more specific to identify active asthma. They are increasingly used to evaluate the prevalence of bronchial hyperresponsiveness and to assess specific problems in patients with known asthma, e.g. exercise-induced bronchoconstriction, evaluation before scuba diving. Direct bronchial responsiveness is only slowly and to a modest extent, influenced by repeated administration of inhaled steroids. Indirect challenges may reflect more closely acute changes in airway inflammation and a change in responsiveness to an indirect stimulus may be a clinically relevant marker to assess the clinical course of asthma. Moreover, some of the indirect challenges, e.g. hypertonic saline and mannitol, can be combined with the assessment of inflammatory cells by induction of sputum. |
| Databáze: | OpenAIRE |
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