Hypertonicity of the challenge solution may increase the diagnostic accuracy of histamine challenge
| Autor: | Minna Purokivi, Jukka T. Randell, Kirsi M. Kontra, Heikki Koskela |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Hypertonic Solutions Asthma diagnosis Sensitivity and Specificity Bronchial Provocation Tests Bronchoconstrictor Agents chemistry.chemical_compound Hypertonic saline medicine Humans Glucocorticoids Asthma Throat irritation Inhalation business.industry Nebulizers and Vaporizers Smoking Respiratory disease Middle Aged medicine.disease Bronchodilator Agents respiratory tract diseases chemistry Bronchial hyperresponsiveness Case-Control Studies Anesthesia Tonicity Female medicine.symptom business Histamine |
| Zdroj: | Respiratory Medicine. 99:726-734 |
| ISSN: | 0954-6111 |
| DOI: | 10.1016/j.rmed.2004.10.019 |
| Popis: | Summary There is significant overlap in the responsiveness to direct airway challenges, such as the histamine challenge, between asthmatic and non-asthmatic subjects, which decreases their accuracy in the diagnosis of asthma. To minimise this overlap, a new test, hypertonic histamine challenge, was developed. Fifteen healthy subjects, 16 subjects with steroid-naive asthma, and 16 asthmatic subjects undergoing inhaled corticosteroid treatment underwent inhalation challenges with hypertonic saline, isotonic histamine, and hypertonic histamine, using an ultrasonic nebuliser and 2-min tidal breathing method. The increase in histamine solution tonicity decreased the histamine PC 20 values only in the steroid-naive asthmatic subjects (1.1 (0.5–2.7) vs. 0.5 (0.2–1.2)mg/ml, P = 0.047 ). Using 1mg/ml as the cut-off value, the sensitivity, specificity, and accuracy of the hypertonic histamine challenge to detect steroid-naive asthma was 81%, 100%, and 90%. The respective values for the isotonic histamine challenge were 56%, 100%, and 77%. Furthermore, there was a statistically significant difference in the hypertonic histamine PC 20 between steroid-naive and steroid-treated asthmatic subjects, which could not be detected in the isotonic histamine PC 20 . The hypertonic histamine PC 20 was highly repeatable, with a single determination 95% range of ±1.35 doubling concentrations. The hypertonic histamine challenge was safe but provoked more cough and throat irritation than the other two challenges. In conclusion, compared with a conventional, isotonic histamine challenge, hypertonic histamine challenge may be more accurate in the diagnosis of asthma and also, more capable to detect the effects of inhaled corticosteroid treatment. |
| Databáze: | OpenAIRE |
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