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Sévoz-Couche C, Liao W, Foo HYC, Bonne I, Lu TB, Tan Qi Hui C, Azhar SH, Peh WYX, Yen SC, Wong WSF. Direct vagus nerve stimulation: A new tool to control allergic airway inflammation through α7 nicotinic acetylcholine receptor. Br J Pharmacol 2024; 181:1916-1934. [PMID: 38430056 DOI: 10.1111/bph.16334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 11/24/2023] [Accepted: 01/08/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND AND PURPOSE Asthma is characterized by airway inflammation, mucus hypersecretion, and airway hyperresponsiveness. The use of nicotinic agents to mimic the cholinergic anti-inflammatory pathway (CAP) controls experimental asthma. Yet, the effects of vagus nerve stimulation (VNS)-induced CAP on allergic inflammation remain unknown. EXPERIMENTAL APPROACH BALB/c mice were sensitized and challenged with house dust mite (HDM) extract and treated with active VNS (5 Hz, 0.5 ms, 0.05-1 mA). Bronchoalveolar lavage (BAL) fluid was assessed for total and differential cell counts and cytokine levels. Lungs were examined by histopathology and electron microscopy. KEY RESULTS In the HDM mouse asthma model, VNS at intensities equal to or above 0.1 mA (VNS 0.1) but not sham VNS reduced BAL fluid differential cell counts and alveolar macrophages expressing α7 nicotinic receptors (α7nAChR), goblet cell hyperplasia, and collagen deposition. Besides, VNS 0.1 also abated HDM-induced elevation of type 2 cytokines IL-4 and IL-5 and was found to block the phosphorylation of transcription factor STAT6 and expression level of IRF4 in total lung lysates. Finally, VNS 0.1 abrogated methacholine-induced hyperresponsiveness in asthma mice. Prior administration of α-bungarotoxin, a specific inhibitor of α7nAChR, but not propranolol, a specific inhibitor of β2-adrenoceptors, abolished the therapeutic effects of VNS 0.1. CONCLUSION AND IMPLICATIONS Our data revealed the protective effects of VNS on various clinical features in allergic airway inflammation model. VNS, a clinically approved therapy for depression and epilepsy, appears to be a promising new strategy for controlling allergic asthma.
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Affiliation(s)
- Caroline Sévoz-Couche
- INSERM, UMRS1158 Neurophysiologie Respiratoire et Clinique, Sorbonne Université, Paris, France
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wupeng Liao
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore-HUJ Alliance for Research and Enterprise (SHARE), National University of Singapore, Singapore
| | - Hazel Y C Foo
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore-HUJ Alliance for Research and Enterprise (SHARE), National University of Singapore, Singapore
| | - Isabelle Bonne
- Electron Microscopy Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Thong Beng Lu
- Electron Microscopy Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Caris Tan Qi Hui
- Advanced imaging and Histology Core, Immunology Program, Life Science Institute, National University of Singapore, Singapore
| | - Syaza Hazwany Azhar
- Advanced imaging and Histology Core, Immunology Program, Life Science Institute, National University of Singapore, Singapore
| | - Wendy Yen Xian Peh
- The N.1 Institute for Health, National University of Singapore, Singapore
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
| | - Shih-Cheng Yen
- The N.1 Institute for Health, National University of Singapore, Singapore
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
| | - W S Fred Wong
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore-HUJ Alliance for Research and Enterprise (SHARE), National University of Singapore, Singapore
- Drug Discovery and Optimization Platform, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Pasha MA, Hopp RJ, Habib N, Tang DD. Biomarkers in asthma, potential for therapeutic intervention. J Asthma 2024:1-16. [PMID: 38805392 DOI: 10.1080/02770903.2024.2361783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/26/2024] [Indexed: 05/30/2024]
Abstract
Asthma is a heterogeneous disease characterized by multiple phenotypes with varying risk factors and therapeutic responses. This Commentary describes research on biomarkers for T2-"high" and T2-"low" inflammation, a hallmark of the disease. Patients with asthma who exhibit an increase in airway T2 inflammation are classified as having T2-high asthma. In this endotype, Type 2 cytokines interleukins (IL)-4, IL-5, and IL-13, plus other inflammatory mediators, lead to increased eosinophilic inflammation and elevated fractional exhaled nitric oxide (FeNO). In contrast, T2-low asthma has no clear definition. Biomarkers are considered valuable tools as they can help identify various phenotypes and endotypes, as well as treatment response to standard treatment or potential therapeutic targets, particularly for biologics. As our knowledge of phenotypes and endotypes expands, biologics are increasingly integrated into treatment strategies for severe asthma. These treatments block specific inflammatory pathways or single mediators. While single or composite biomarkers may help to identify subsets of patients who might benefit from these treatments, only a few inflammatory biomarkers have been validated for clinical application. One example is sputum eosinophilia, a particularly useful biomarker, as it may suggest corticosteroid responsiveness or reflect non-compliance to inhaled corticosteroids. As knowledge develops, a meaningful goal would be to provide individualized care to patients with asthma.
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Affiliation(s)
- M Asghar Pasha
- Department of Medicine, Division of Allergy and Immunology, Albany Medical College, Albany, NY, USA
| | - Russell J Hopp
- Department of Pediatrics, University of NE Medical Center and Children's Hospital and Medical Center, Omaha, NE, USA
| | - Nazia Habib
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, USA
| | - Dale D Tang
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, USA
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Romero-Falcón MA, Medina-Gallardo JF, Lopez-Campos JL, Maestre Sánchez MV, Soler Chamorro MJ, Regalado Alvertos E, Álvarez-Gutiérrez FJ. Evaluation of the Diagnostic Accuracy of Non-Specific Bronchial Provocation Tests in the Diagnosis of Asthma: A Randomized Cross-Over Study. Arch Bronconeumol 2023; 59:76-83. [PMID: 36371327 DOI: 10.1016/j.arbres.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The role of bronchial provocation tests in the diagnosis of asthma remains to be fully explored. We aimed to evaluate methacholine and mannitol challenge testing, and explore the factors associated with this broncoprovocation response. METHODS Observational, cross-over, randomized trial evaluating adult cases with suspected asthma, naïve to treatment, with normal pre-bronchodilator spirometry, and negative bronchodilator test. Patients were randomized to start with methacholine or mannitol. The diagnosis of bronchial asthma was confirmed if there was a good functional and clinical response to one month with twice daily formoterol/budesonide 9/320. The diagnostic profile and the concordance were calculated. Factors associated with a positive provocation test were entered into a multivariate binomial logistic regression analysis, and classification trees were created for both tests. RESULTS The study included 108 cases (50.0% diagnosed with asthma and 51.9% cases starting with methacholine). The percentage of cases positive to methacholine and mannitol were 30.6% and 25.0% respectively. Kappa values were 0.40 (p<0.001). The diagnostic profile for methacholine was sensitivity 59.3% and specificity 98.1%, while for mannitol it was sensitivity 48.1% and specificity 98.1%. Variables associated with a positive methacholine response included sex, atopy, FEV1, FEV1/FVC and FENO, whereas they were FEV1/FVC and FENO for mannitol. A FENO value>26ppb, FEV1≤103.3% and female sex correctly classified 78.7% of methacholine responders. FENO value>26ppb was enough to correctly classify 81.5% of mannitol responders. CONCLUSIONS Our study confirms the diagnostic profile of methacholine and mannitol challenge tests and describes the variable associated to their positivity with new proposed cutoff values.
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Affiliation(s)
- María Auxiliadora Romero-Falcón
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Spain
| | - Juan Francisco Medina-Gallardo
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Spain
| | - Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Spain; Facultad de Medicina, Universidad de Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Mª Victoria Maestre Sánchez
- Servicio de Uso Racional del Medicamento, Subdirección de Farmacia y Prestaciones, Servicio Andaluz de Salud, Spain
| | - Mª Jesús Soler Chamorro
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Spain
| | - Elena Regalado Alvertos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Spain
| | - Francisco Javier Álvarez-Gutiérrez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Spain
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Kim Y, Lee H, Chung SJ, Yeo Y, Park TS, Park DW, Min KH, Kim SH, Kim TH, Sohn JW, Moon JY, Yoon HJ. The Usefulness of FEF 25-75 in Predicting Airway Hyperresponsiveness to Mannitol. J Asthma Allergy 2021; 14:1267-1275. [PMID: 34737579 PMCID: PMC8560169 DOI: 10.2147/jaa.s318502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Despite the usefulness of airway hyperresponsiveness (AHR) testing in diagnosing and monitoring asthma, it is challenging to perform in a real-world setting. Forced expiratory flow between 25% and 75% of vital capacity (FEF25-75), a pulmonary measurement that can be obtained easily during routine spirometry, represents the status of medium-sized and small airways. However, the performance of FEF25-75 in predicting AHR has not been well elucidated. Therefore, we investigated whether FEF25-75 can predict AHR to mannitol. Methods We performed a retrospective cohort study of 428 patients who visited a single clinic due to cough, wheezing, or dyspnea. All patients underwent spirometry with a mannitol provocation test. We compared the area under the curve (AUC) of the percentage of the predicted values of FEF25-75 (FEF25-75 %pred) with that of forced expiratory volume in 1 second (FEV1%pred), FEV1/forced vital capacity (FVC), and FEF25-75/ FVC for predicting AHR. Results The rate of AHR to mannitol was 20.3%. In the overall study population, the AUC of FEF25-75 %pred for predicting AHR (0.772; 95% confidence interval [CI], 0.729-0.811) was significantly higher than that of FEV1%pred (0.666; 95% CI, 0.619-0.710; p < 0.001), FEV1/FVC (0.741; 95% CI, 0.697-0.782; p = 0.047), and FEF25-75/FVC (0.741, 95% CI = 0.696-0.782, p = 0.046). The sensitivity, specificity, positive predictive value, and negative predictive value of FEF25-75 %pred <81% for predicting AHR in the overall study population were 77.0% (95% CI = 66.8-85.4%), 63.9% (95% CI = 58.6-69.0), 35.3%, and 91.6%, respectively. When we restricted the study group to subjects with normal lung function, the results were similar. Conclusion Our results indicate that FEF25-75 %pred can be used as a surrogate for predicting AHR in patients with respiratory symptoms.
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Affiliation(s)
- Youlim Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea
| | - Hyun Lee
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Sung Jun Chung
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Yoomi Yeo
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Tai Sun Park
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Dong Won Park
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyung Hoon Min
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Tae-Hyung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Jang Won Sohn
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
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Abstract
This article will discuss in detail the pathophysiology of asthma from the point of view of lung mechanics. In particular, we will explain how asthma is more than just airflow limitation resulting from airway narrowing but in fact involves multiple consequences of airway narrowing, including ventilation heterogeneity, airway closure, and airway hyperresponsiveness. In addition, the relationship between the airway and surrounding lung parenchyma is thought to be critically important in asthma, especially as related to the response to deep inspiration. Furthermore, dynamic changes in lung mechanics over time may yield important information about asthma stability, as well as potentially provide a window into future disease control. All of these features of mechanical properties of the lung in asthma will be explained by providing evidence from multiple investigative methods, including not only traditional pulmonary function testing but also more sophisticated techniques such as forced oscillation, multiple breath nitrogen washout, and different imaging modalities. Throughout the article, we will link the lung mechanical features of asthma to clinical manifestations of asthma symptoms, severity, and control. © 2020 American Physiological Society. Compr Physiol 10:975-1007, 2020.
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Affiliation(s)
- David A Kaminsky
- University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - David G Chapman
- University of Technology Sydney, Sydney, New South Wales, Australia
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Lee J, Song JU. Diagnostic comparison of methacholine and mannitol bronchial challenge tests for identifying bronchial hyperresponsiveness in asthma: a systematic review and meta-analysis. J Asthma 2020; 58:883-891. [PMID: 32138564 DOI: 10.1080/02770903.2020.1739704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Bronchial hyperresponsiveness (BHR) is a representative feature of asthma. Although methacholine and mannitol are commonly used for bronchial challenge tests, the optimal roles of the two agents for assessing BHR remain unclear. We compared the diagnostic performance of methacholine and mannitol in bronchial challenge tests. METHODS A systematic literature search was performed using MEDLINE, EMBASE, and the Cochrane Central Register. The sensitivity, specificity, diagnostic odds ratio (DOR), and a hierarchical summary of the receiver-operating characteristic curve (HSROC) of the two agents for detecting BHR in asthma were pooled using meta-analysis. A meta-regression analysis was used to identify potential sources of heterogeneity within the selected studies. RESULTS We identified six studies comprising 565 patients. The pooled sensitivity, specificity, and DOR of methacholine were 0.61 (95%CI, 0.44-0.76), 0.93 (95%CI, 0.70-0.99), and 23.47 (95% CI, 2.51-219.89), respectively. The pooled sensitivity, specificity, and diagnostic odds ratio of mannitol were 0.50 (95%CI, 0.28-0.73), 0.97 (95% CI, 0.94-0.99), and 35.22 (95% CI, 8.82-140.62), respectively. The area under the HSROC for mannitol was higher than that for methacholine (0.97 vs. 0.81, p < 0.01). Considerable between-study heterogeneity was present for sensitivity and specificity in studies of both index tests. Univariate meta-regression analysis revealed that age and sex of the study participants were probable sources of heterogeneity for specificity in studies of methacholine. CONCLUSION Although mannitol showed better diagnostic performance than methacholine for identifying BHR in asthma, substantial between-study heterogeneity necessitates caution when interpreting the data.
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Affiliation(s)
- Jonghoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea
| | - Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Cockcroft DW, Davis BE, Blais CM. Comparison of methacholine and mannitol challenges: importance of method of methacholine inhalation. Allergy Asthma Clin Immunol 2020; 16:14. [PMID: 32082392 PMCID: PMC7014722 DOI: 10.1186/s13223-020-0410-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background Direct inhalation challenges (e.g. methacholine) are stated to be more sensitive and less specific for a diagnosis of asthma than are indirect challenges (e.g. exercise, non-isotonic aerosols, mannitol, etc.). However, data surrounding comparative sensitivity and specificity for methacholine compared to mannitol challenges are conflicting. When methacholine is inhaled by deep total lung capacity (TLC) inhalations, deep inhalation inhibition of bronchoconstriction leads to a marked loss of diagnostic sensitivity when compared to tidal breathing (TB) inhalation methods. We hypothesized that deep inhalation methacholine methods with resulting bronchoprotection may be the explanation for conflicting sensitivity/specificity data. Methods We reviewed 27 studies in which methacholine and mannitol challenges were performed in largely the same individuals. Methacholine was inhaled by dosimeter TLC methods in 13 studies and by tidal breathing in 14 studies. We compared the rates of positive methacholine (stratified by inhalation method) and mannitol challenges in both asthmatics and non-asthmatics. Results When methacholine was inhaled by TLC inhalations the prevalence of positive tests in asthmatics, 60.2% (548/910), was similar to mannitol, 58.9% (537/912). By contrast, when methacholine was inhaled by tidal breathing the prevalence of positive tests in asthmatics 83.1% (343/413) was more than double that of mannitol, 41.5% (146/351). In non-asthmatics, the two methacholine methods resulted in positive tests in 18.8% (142/756) and 16.2% (27/166) by TLC and TB inhalations respectively. This compares to an overall 8.3% (n = 76) positive rate for mannitol in 913 non-asthmatics. Conclusion These data support the hypothesis that the conflicting data comparing methacholine and mannitol sensitivity and specificity are due to the method of methacholine inhalation. Tidal breathing methacholine methods have a substantially greater sensitivity for a diagnosis of asthma than either TLC dosimeter methacholine challenge methods or mannitol challenge. Methacholine challenges should be performed by tidal breathing as per recent guideline recommendations. Methacholine (more sensitive) and mannitol (more specific) will thus have complementary diagnostic features.
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Affiliation(s)
- Donald W Cockcroft
- 1Department of Medicine, University of Saskatchewan, Saskatoon, SK Canada.,2Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N0W8 Canada
| | - Beth E Davis
- 1Department of Medicine, University of Saskatchewan, Saskatoon, SK Canada
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Comberiati P, Katial RK, Covar RA. Bronchoprovocation Testing in Asthma: An Update. Immunol Allergy Clin North Am 2019; 38:545-571. [PMID: 30342579 DOI: 10.1016/j.iac.2018.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Bronchial hyperresponsiveness (BHR) is defined as a heightened bronchoconstrictive response to airway stimuli. It complements the cardinal features in asthma, such as variable or reversible airflow limitation and airway inflammation. Although BHR is considered a pathophysiologic hallmark of asthma, it should be acknowledged that this property of the airway is dynamic, because its severity and even presence can vary over time with disease activity, triggers or specific exposure, and with treatment. In addition, it is important to recognize that there is a component that is not reflective of a specific disease entity.
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Affiliation(s)
- Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, 56126 Pisa, Italy; Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Rohit K Katial
- National Jewish Health, 1400 Jackson Street (J321), Denver, CO 80206, USA
| | - Ronina A Covar
- National Jewish Health, 1400 Jackson Street (J321), Denver, CO 80206, USA.
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Plantier L, Beydon N, Chambellan A, Degano B, Delclaux C, Dewitte JD, Dinh-Xuan AT, Garcia G, Kauffmann C, Paris C, Perez T, Poussel M, Wuyam B, Zerah-Lancner F, Chenuel B. [Guidelines for methacholine provocation testing]. Rev Mal Respir 2018; 35:759-775. [PMID: 30097294 DOI: 10.1016/j.rmr.2018.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/15/2018] [Indexed: 12/01/2022]
Abstract
Bronchial challenge with the direct bronchoconstrictor agent methacholine is commonly used for the diagnosis of asthma. The "Lung Function" thematic group of the French Pulmonology Society (SPLF) elaborated a series of guidelines for the performance and the interpretation of methacholine challenge testing, based on French clinical guideline methodology. Specifically, guidelines are provided with regard to the choice of judgment criteria, the management of deep inspirations, and the role of methacholine bronchial challenge in the care of asthma, exercise-induced asthma, and professional asthma.
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Affiliation(s)
- L Plantier
- CEPR/Inserm UMR1100, CHRU de Tours, service de pneumologie et explorations fonctionnelles respiratoires, université François-Rabelais, 37044 Tours cedex 9, France.
| | - N Beydon
- Unité fonctionnelle d'exploration fonctionnelle respiratoire et du sommeil, AP-HP, hôpital Armand-Trousseau, 75012 Paris, France
| | - A Chambellan
- Inserm UMR1087, explorations fonctionnelles et réhabilitation respiratoire, l'institut du thorax, CHU, 44093 Nantes cedex 1, France
| | - B Degano
- Service d'explorations fonctionnelles, hôpital Jean-Minjoz, 25000 Besançon, France
| | - C Delclaux
- Inserm U1141, DHU PROTECT, service de physiologie explorations fonctionnelles pédiatriques-CPPS, AP-HP, hôpital Robert-Debré, université Paris Diderot, 75019 Paris, France
| | - J-D Dewitte
- Santé au travail-laboratoire d'étude et de recherche en sociologie, UFR médecine et sciences de la santé, université de Bretagne occidentale, 29238 Brest cedex 3, France
| | - A T Dinh-Xuan
- Service de physiologie-explorations fonctionnelles, université Paris Descartes, AP-HP, hôpital Cochin, 75014 Paris, France
| | - G Garcia
- Service de physiologie, Inserm UMR999, AP-HP, hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre cedex, France
| | - C Kauffmann
- Service d'explorations fonctionnelles respiratoires, CHU, 63000 Clermont-Ferrand, France
| | - C Paris
- EA7892, service de pathologie professionnelle, université de Lorraine, CHU de Nancy, 54500 Vandœuvre-Les-Nancy, France
| | - T Perez
- Clinique de pneumologie, centre de compétences maladies pulmonaires rares, CHRU de Lille, hôpital Albert-Calmette, 59037 Lille, France
| | - M Poussel
- Antenne médicale de prévention du dopage, EA 3450, service des examens de la fonction respiratoire et de l'aptitude à l'exercice médecine du sport, CHRU de Nancy Brabois, 54500 Vandœuvre-lès-Nancy, France
| | - B Wuyam
- Laboratoire HP2, Inserm 1042, service sport et pathologies, CHU de Grenoble, hôpital Sud, 38130 Echirolles, France
| | - F Zerah-Lancner
- Service de physiologie-explorations fonctionnelles, AP-HP, hôpital Henri-Mondor, 94000 Créteil, France
| | - B Chenuel
- Antenne médicale de prévention du dopage, EA 3450, service des examens de la fonction respiratoire et de l'aptitude à l'exercice médecine du sport, CHRU de Nancy Brabois, 54500 Vandœuvre-lès-Nancy, France
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Lim KH, Kim MH, Yang MS, Song WJ, Jung JW, Lee J, Suh DI, Shin YS, Kwon JW, Kim SH, Kim SH, Lee BJ, Cho SH. The KAAACI Standardization Committee Report on the procedure and application of the bronchial provocation tests. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.1.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kyung-Hwan Lim
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeongmin Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Caggiano S, Cutrera R, Di Marco A, Turchetta A. Exercise-Induced Bronchospasm and Allergy. Front Pediatr 2017; 5:131. [PMID: 28642859 PMCID: PMC5462910 DOI: 10.3389/fped.2017.00131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/17/2017] [Indexed: 01/02/2023] Open
Abstract
Sport is an essential part of childhood, with precious and acknowledged positive health effects but the impact of exercise-induced bronchoconstriction (EIB) significantly reduces participation in physical activity. It is important to recognize EIB, differentiating EIB with or without asthma if the transient narrowing of the airways after exercise is associated with asthmatic symptoms or not, in the way to select the most appropriate treatment among the many treatment options available today. Therapy is prescribed based on symptoms severity but diagnosis of EIB is established by changes in lung function provoked by exercise evaluating by direct and indirect tests. Sometimes, in younger children it is difficult to obtain the registration of difference between the preexercise forced expiratory volume in the first second (FEV1) value and the lowest FEV1 value recorded within 30 min after exercise, defined as the gold standard, but interrupter resistance, in association with spirometry, has been showed to be a valid alternative in preschool age. Atopy is the main risk factor, as demonstrated by epidemiologic data showing that among the estimated pediatric population with EIB up to 40% of them have allergic rhinitis and 30% of these patients may develop adult asthma, according with atopic march. Adopting the right treatment and prevention, selecting sports with no marked hyperventilation and excessive cooling of the airways, children with EIB can be able to take part in physical activity like all others.
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Affiliation(s)
- Serena Caggiano
- Respiratory Intermediate Care Unit, Pediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
- Sleep and Long Term Ventilation Unit, Pediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Renato Cutrera
- Respiratory Intermediate Care Unit, Pediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
- Sleep and Long Term Ventilation Unit, Pediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Antonio Di Marco
- Respiratory Intermediate Care Unit, Pediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
- Sleep and Long Term Ventilation Unit, Pediatric Department, Bambino Gesù Children’s Hospital, Rome, Italy
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12
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Porpodis K, Domvri K, Kontakiotis T, Fouka E, Kontakioti E, Zarogoulidis K, Papakosta D. Comparison of diagnostic validity of mannitol and methacholine challenges and relationship to clinical status and airway inflammation in steroid-naïve asthmatic patients. J Asthma 2016; 54:520-529. [PMID: 27686218 DOI: 10.1080/02770903.2016.1238926] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of this study was to demonstrate and compare the diagnostic validity of two bronchial challenges and to investigate their correlation with patient clinical status, atopy and inflammation markers. METHODS Eighty-eight patients, 47 women and 41 men, mean age 38.56 ± 16.73 years who presented with asthma related symptoms and were not on any anti-asthma medication, were challenged with mannitol and methacholine on separate days. Medical history regarding asthmatic symptoms, physical examination, skin prick tests and FeNO levels were also assessed. The clinical diagnosis of asthma was based on bronchodilator reversibility test. RESULTS Sixty-seven patients were diagnosed with asthma and 21 without asthma. Both methacholine (P < 0.014) and mannitol (P < 0.000) challenges were significant in diagnosing asthma. The positive/negative predictive value was 93.33%/41.86% for methacholine, 97.72%/45.45% for mannitol and 97.05%/45.45%. for both methods assessed together. Worthy of note that 22% of asthmatics had both tests negative. There was a negative correlation between PC20 of methacholine and the FeNO level P < 0.001, and positive with the PD15 of mannitol P < 0.001 and the pre-test FEV1% pred P < 0.005, whereas PD15 of mannitol was negatively correlated with the FeNO level P < 0.001. Furthermore, dyspnea was the only asthmatic symptom associated with FeNO level P < 0.035 and the positivity of mannitol P < 0.014 and methacholine P < 0.04. CONCLUSIONS Both challenge tests were equivalent in diagnosing asthma. Nevertheless, specificity appeared to be slightly higher in mannitol challenge.
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Affiliation(s)
- Konstantinos Porpodis
- a Department of Pulmonary Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Kalliopi Domvri
- a Department of Pulmonary Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Theodoros Kontakiotis
- a Department of Pulmonary Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Evangelia Fouka
- a Department of Pulmonary Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Eirini Kontakioti
- a Department of Pulmonary Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | | | - Despina Papakosta
- a Department of Pulmonary Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
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13
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Del Giacco SR, Firinu D, Bjermer L, Carlsen KH. Exercise and asthma: an overview. Eur Clin Respir J 2015. [PMID: 26672959 DOI: 10.3402/ecrj.v2.27984.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The terms 'exercise-induced asthma' (EIA) and 'exercise-induced bronchoconstriction' (EIB) are often used interchangeably to describe symptoms of asthma such as cough, wheeze, or dyspnoea provoked by vigorous physical activity. In this review, we refer to EIB as the bronchoconstrictive response and to EIA when bronchoconstriction is associated with asthma symptoms. EIB is a common occurrence for most of the asthmatic patients, but it also affects more than 10% of otherwise healthy individuals as shown by epidemiological studies. EIA and EIB have a high prevalence also in elite athletes, especially within endurance type of sports, and an athlete's asthma phenotype has been described. However, the occurrence in elite athletes shows that EIA/EIB, if correctly managed, may not impair physical activity and top sports performance. The pathogenic mechanisms of EIA/EIB classically involve both osmolar and vascular changes in the airways in addition to cooling of the airways with parasympathetic stimulation. Airways inflammation plays a fundamental role in EIA/EIB. Diagnosis and pharmacological management must be carefully performed, with particular consideration of current anti-doping regulations, when caring for athletes. Based on the demonstration that the inhaled asthma drugs do not improve performance in healthy athletes, the doping regulations are presently much less strict than previously. Some sports are at a higher asthma risk than others, probably due to a high environmental exposure while performing the sport, with swimming and chlorine exposure during swimming as one example. It is considered very important for the asthmatic child and adolescent to master EIA/EIB to be able to participate in physical activity on an equal level with their peers, and a precise early diagnosis with optimal treatment follow-up is vital in this aspect. In addition, surprising recent preliminary evidences offer new perspectives for moderate exercise as a potential therapeutic tool for asthmatics.
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Affiliation(s)
- Stefano R Del Giacco
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy;
| | - Davide Firinu
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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14
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Chapman DG, Irvin CG. Mechanisms of airway hyper-responsiveness in asthma: the past, present and yet to come. Clin Exp Allergy 2015; 45:706-19. [PMID: 25651937 DOI: 10.1111/cea.12506] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Airway hyper-responsiveness (AHR) has long been considered a cardinal feature of asthma. The development of the measurement of AHR 40 years ago initiated many important contributions to our understanding of asthma and other airway diseases. However, our understanding of AHR in asthma remains complicated by the multitude of potential underlying mechanisms which in reality are likely to have different contributions amongst individual patients. Therefore, the present review will discuss the current state of understanding of the major mechanisms proposed to contribute to AHR and highlight the way in which AHR testing is beginning to highlight distinct abnormalities associated with clinically relevant patient populations. In doing so we aim to provide a foundation by which future research can begin to ascribe certain mechanisms to specific patterns of bronchoconstriction and subsequently match phenotypes of bronchoconstriction with clinical phenotypes. We believe that this approach is not only within our grasp but will lead to improved mechanistic understanding of asthma phenotypes and we hoped to better inform the development of phenotype-targeted therapy.
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Affiliation(s)
- D G Chapman
- Woolcock Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
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15
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Del Giacco SR, Firinu D, Bjermer L, Carlsen KH. Exercise and asthma: an overview. Eur Clin Respir J 2015; 2:27984. [PMID: 26672959 PMCID: PMC4653278 DOI: 10.3402/ecrj.v2.27984] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 09/04/2015] [Indexed: 01/03/2023] Open
Abstract
The terms 'exercise-induced asthma' (EIA) and 'exercise-induced bronchoconstriction' (EIB) are often used interchangeably to describe symptoms of asthma such as cough, wheeze, or dyspnoea provoked by vigorous physical activity. In this review, we refer to EIB as the bronchoconstrictive response and to EIA when bronchoconstriction is associated with asthma symptoms. EIB is a common occurrence for most of the asthmatic patients, but it also affects more than 10% of otherwise healthy individuals as shown by epidemiological studies. EIA and EIB have a high prevalence also in elite athletes, especially within endurance type of sports, and an athlete's asthma phenotype has been described. However, the occurrence in elite athletes shows that EIA/EIB, if correctly managed, may not impair physical activity and top sports performance. The pathogenic mechanisms of EIA/EIB classically involve both osmolar and vascular changes in the airways in addition to cooling of the airways with parasympathetic stimulation. Airways inflammation plays a fundamental role in EIA/EIB. Diagnosis and pharmacological management must be carefully performed, with particular consideration of current anti-doping regulations, when caring for athletes. Based on the demonstration that the inhaled asthma drugs do not improve performance in healthy athletes, the doping regulations are presently much less strict than previously. Some sports are at a higher asthma risk than others, probably due to a high environmental exposure while performing the sport, with swimming and chlorine exposure during swimming as one example. It is considered very important for the asthmatic child and adolescent to master EIA/EIB to be able to participate in physical activity on an equal level with their peers, and a precise early diagnosis with optimal treatment follow-up is vital in this aspect. In addition, surprising recent preliminary evidences offer new perspectives for moderate exercise as a potential therapeutic tool for asthmatics.
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Affiliation(s)
- Stefano R Del Giacco
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy;
| | - Davide Firinu
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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16
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Zaczeniuk M, Woicka-Kolejwa K, Stelmach W, Podlecka D, Jerzyńska J, Stelmach I. Methacholine challenge testing is superior to the exercise challenge for detecting asthma in children. Ann Allergy Asthma Immunol 2015; 115:481-4. [PMID: 26602490 DOI: 10.1016/j.anai.2015.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/17/2015] [Accepted: 09/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exercise-induced bronchoconstriction occurs in a large proportion of children with asthma. OBJECTIVE To compare the predictive value of methacholine challenge testing (MCCT) and the exercise treadmill challenge (ETC) for detecting asthma in children with postexercise symptoms. METHODS This was a prospective study of children 10 to 18 years old with postexercise symptoms. During asthma diagnosis, they underwent MCCT and ETC. There were 2 study visits. All subjects underwent ECT at visit 1 and MCCT 1 week later at visit 2. RESULTS One hundred one children were included; 62.9% had a history of atopy, and asthma was confirmed in 43.6%. MCCT showed 90.9% sensitivity, 82.5% specificity, 80.0% positive predictive value, and 92.2% negative predictive value; the respective values for ECT were 77.3%, 68.4%, 65.4%, and 79.6%. Positive MCCT results showed significantly higher sensitivity and higher positive predicative value in the diagnosis of asthma in children with postexercise symptoms compared with a 10% decrease in forced expiratory volume in 1 second for ECT (P = 0.034). Conducting MCCT during asthma diagnosis confirmed asthma in an additional 24.3% of children with exercise-induced symptoms. With a cutoff level at 17% of forced expiratory volume in 1 second for ECT, the discrepancy was decreased and reasonable values for sensitivity, specificity, positive predictive value, and negative predictive value were attained (61.0%, 77.1%, 69.4%, and 69.8%, respectively). CONCLUSION A large number of school children with asthma and postexercise symptoms could have positive MCCT and negative ECT findings. Untreated asthma in children with exercise-induced bronchoconstriction could cause them to be discharged from physical education classes. TRIAL REGISTRATION www.ClinicalTrials.gov, identifier NCT01798823.
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Affiliation(s)
- Magdalena Zaczeniuk
- Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland
| | | | - Wlodzimierz Stelmach
- Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - Daniela Podlecka
- Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland
| | - Joanna Jerzyńska
- Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland
| | - Iwona Stelmach
- Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland.
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