Bronchodilation Test with Inhaled Salbutamol Versus Bronchial Methacholine Challenge to Make an Asthma Diagnosis: Do They Provide the Same Information?
[en] BACKGROUND: Methacholine bronchial challenge and bronchodilation to salbutamol are key tests in clinical practice to make asthma diagnosis. OBJECTIVE: To assess the concordance between the 2 tests and to see whether they actually identify the same population of asthmatics. METHOD: We conducted a retrospective study using our asthma clinic database to see how methacholine bronchial challenge compared to bronchodilation to salbutamol in untreated patients with recurrent or chronic symptoms suspicious of asthma. We identified 194 untreated patients with baseline forced expiratory volume in 1 second (FEV(1)) ≥70% predicted who had both a bronchodilation test with salbutamol and a methacholine bronchial challenge 7 to 14 days apart. A positive bronchial challenge was a provocative concentration of methacholine causing a 20% fall in FEV(1) ≤16 mg/mL, whereas a positive bronchodilation test was a reversibility to 400 μg inhaled salbutamol ≥12% from baseline and 200 mL. RESULTS: Overall, asthma diagnosis was confirmed in 91% of cases leaving 9% of subjects with double negative tests. Isolated positive methacholine challenge was found in 71% of subjects, double positive tests in 17%, whereas isolated significant bronchodilation to salbutamol was rare (3%). There was no correlation between provocative concentration of methacholine causing a fall in FEV(1) of 20% (PC20M) and the magnitude of salbutamol reversibility (P = .10). Baseline FEV(1)/forced vital capacity ratio inversely correlated with reversibility to salbutamol (P < .001) but not with PC20M (P = .1). No difference was found between the groups regarding demographic and immunoinflammatory features, including the proportion of eosinophilic asthma. CONCLUSION: We conclude that methacholine challenge outperforms reversibility to salbutamol to diagnose asthma without selecting patients with distinct inflammatory profile. Baseline airway obstruction predicts magnitude of reversibility but not hyperresponsiveness.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Louis, Renaud ; Université de Liège - ULiège > Département des sciences cliniques > Pneumologie - Allergologie
Bougard, Nicolas ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de cardiologie
GUISSARD, Françoise ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Clinique de l'asthme
PAULUS, Virginie ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Clinique de l'asthme
HENKET, Monique ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Clinique de l'asthme
Schleich, Florence ; Université de Liège - ULiège > Département des sciences de la motricité > Département des sciences de la motricité
Language :
English
Title :
Bronchodilation Test with Inhaled Salbutamol Versus Bronchial Methacholine Challenge to Make an Asthma Diagnosis: Do They Provide the Same Information?
Publication date :
February 2020
Journal title :
Journal of Allergy and Clinical Immunology: In Practice
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Bibliography
Aaron, S.D., Vandemheen, K.L., FitzGerald, J.M., Ainslie, M., Gupta, S., Lemiere, C., et al. Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA 317 (2017), 269–279.
Global Initiative of Asthma 2019. Global Strategy for Asthma Management and Prevention. Available from: ginasthma.org. Accessed June 15, 2019.
Nair, P., Martin, J.G., Cockcroft, D.C., Dolovich, M., Lemiere, C., Boulet, L.P., et al. Airway hyperresponsiveness in asthma: measurement and clinical relevance. J Allergy Clin Immunol Pract 5 (2017), 649–659.
Boushey, H.A., Sorkness, C.A., King, T.S., Sullivan, S.D., Fahy, J.V., Lazarus, S.C., et al. Daily versus as-needed corticosteroids for mild persistent asthma. N Engl J Med 352 (2005), 1519–1528.
Goldstein, M.F., Veza, B.A., Dunsky, E.H., Dvorin, D.J., Belecanech, G.A., Haralabatos, I.C., Comparisons of peak diurnal expiratory flow variation, postbronchodilator FEV(1) responses, and methacholine inhalation challenges in the evaluation of suspected asthma. Chest 119 (2001), 1001–1010.
Hunter, C.J., Brightling, C.E., Woltmann, G., Wardlaw, A.J., Pavord, I.D., A comparison of the validity of different diagnostic tests in adults with asthma. Chest 121 (2002), 1051–1057.
Demarche, S., Schleich, F., Henket, M., Paulus, V., Van, H.T., Louis, R., Detailed analysis of sputum and systemic inflammation in asthma phenotypes: are paucigranulocytic asthmatics really non-inflammatory?. BMC Pulm Med, 16, 2016, 46.
Schleich, F.N., Manise, M., Sele, J., Henket, M., Seidel, L., Louis, R., Distribution of sputum cellular phenotype in a large asthma cohort: predicting factors for eosinophilic vs neutrophilic inflammation. BMC Pulm Med, 13, 2013, 11.
Juniper, E.F., O'Byrne, P.M., Guyatt, G.H., Ferrie, P.J., King, D.R., Development and validation of a questionnaire to measure asthma control. Eur Respir J 14 (1999), 902–907.
Juniper, E.F., Guyatt, G.H., Cox, F.M., Ferrie, P.J., King, D.R., Development and validation of the Mini Asthma Quality of Life Questionnaire. Eur Respir J 14 (1999), 32–38.
Delvaux, M., Henket, M., Lau, L., Kange, P., Bartsch, P., Djukanovic, R., et al. Nebulised salbutamol administered during sputum induction improves bronchoprotection in patients with asthma. Thorax 59 (2004), 111–115.
Quaedvlieg, V., Sele, J., Henket, M., Louis, R., Association between asthma control and bronchial hyperresponsiveness and airways inflammation: a cross-sectional study in daily practice. Clin Exp Allergy 39 (2009), 1822–1829.
Appleton, S.L., Adams, R.J., Wilson, D.H., Taylor, A.W., Ruffin, R.E., Spirometric criteria for asthma: adding further evidence to the debate. J Allergy Clin Immunol 116 (2005), 976–982.
Ryan, G., Latimer, K.M., Dolovich, J., Hargreave, F.E., Bronchial responsiveness to histamine: relationship to diurnal variation of peak flow rate, improvement after bronchodilator, and airway calibre. Thorax 37 (1982), 423–429.
Ulrik, C.S., Bronchial responsiveness to inhaled histamine in both adults with intrinsic and extrinsic asthma: the importance of prechallenge forced expiratory volume in 1 second. J Allergy Clin Immunol 91 (1993), 120–126.
Shore, S.A., Airway smooth muscle in asthma—not just more of the same. N Engl J Med 351 (2004), 531–532.
Dupont, L.J., Rochette, F., Demedts, M.G., Verleden, G.M., Exhaled nitric oxide correlates with airway hyperresponsiveness in steroid-naive patients with mild asthma. Am J Respir Crit Care Med 157 (1998), 894–898.
Louis, R., Sele, J., Henket, M., Cataldo, D., Bettiol, J., Seiden, L., et al. Sputum eosinophil count in a large population of patients with mild to moderate steroid-naive asthma: distribution and relationship with methacholine bronchial hyperresponsiveness. Allergy 57 (2002), 907–912.
Manise, M., Holtappels, G., Van, C.K., Schleich, F., Bachert, C., Louis, R., Sputum IgE and cytokines in asthma: relationship with sputum cellular profile. PLoS One, 8, 2013, e58388.
Pavord, I.D., Beasley, R., Agusti, A., Anderson, G.P., Bel, E., Brusselle, G., et al. After asthma: redefining airways diseases. Lancet 391 (2018), 350–400.
Demarche, S.F., Schleich, F.N., Henket, M.A., Paulus, V.A., Van Hees, T.J., Louis, R.E., Effectiveness of inhaled corticosteroids in real life on clinical outcomes, sputum cells and systemic inflammation in asthmatics: a retrospective cohort study in a secondary care centre. BMJ Open, 7, 2017, e018186.
McGrath, K.W., Icitovic, N., Boushey, H.A., Lazarus, S.C., Sutherland, E.R., Chinchilli, V.M., et al. A large subgroup of mild-to-moderate asthma is persistently noneosinophilic. Am J Respir Crit Care Med 185 (2012), 612–619.
Schleich, F., Brusselle, G., Louis, R., Vandenplas, O., Michils, A., Pilette, C., et al. Heterogeneity of phenotypes in severe asthmatics. The Belgian Severe Asthma Registry (BSAR). Respir Med 108 (2014), 1723–1732.
Louis, R., Lau, L.C., Bron, A.O., Roldaan, A.C., Radermecker, M., Djukanovic, R., The relationship between airways inflammation and asthma severity. Am J Respir Crit Care Med 161 (2000), 9–16.
Shaw, D., Green, R., Berry, M., Mellor, S., Hargadon, B., Shelley, M., et al. A cross-sectional study of patterns of airway dysfunction, symptoms and morbidity in primary care asthma. Prim Care Respir J 21 (2012), 283–287.
Albert, P., Agusti, A., Edwards, L., Tal-Singer, R., Yates, J., Bakke, P., et al. Bronchodilator responsiveness as a phenotypic characteristic of established chronic obstructive pulmonary disease. Thorax 67 (2012), 701–708.
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