Abstract:
:Methacholine challenge testing (MCT) is widely used to assess airway hyperresponsiveness (AHR). Traditionally, a 20% or greater decline in forced expiratory volume in 1 (FEV(1)) is the primary outcome measure. We examined whether the inclusion of wheeze detection as outcome measure influenced the categorical interpretation of MCT in workers at risk of occupational asthma (OA). We examined 28 occupationally exposed smokers with asthma-like symptoms (SympAsth), 22 asymptomatic, occupationally exposed smokers (Symp0), and 30 nonexposed, asymptomatic controls (Ctrl). MCT was done using an abbreviated technique. Spirometry and tracheal wheezes were recorded using a computerized system. MCT was considered either positive or negative using three outcome measures separately: (1) > or = 20% fall in FEV(1) (MCT("FEV1")); (2) wheeze appearance (MCT("Wheeze")); and (3) whichever among the two was present (MCT("FEV1Wheeze")). The proportion of reactors in each group were, by outcome measure, as follows: MCT("FEV1"): Ctrl = 2 (6.7%), Symp0 = 6 (27.3%), SympAsth = l2 (42.8%) (chi(2) = 10.2; p = 0.006); MCT("Wheeze"): Ctrl = 1 (3.3%), Symp0 = 4 (18.2%), SympAsth = 13 (46.4%) (chi(2) = l5.7; p = 0.001); MCT("FEV1Wheeze") Ctrl = 2 (6.7%), Symp0 = 7 (31.8%), SympAsth = 18 (64.3%) (chi(2) = 21.5; p = 0.001). Overall, including wheeze detection increased the proportion of "reactors" detected by spirometry by 30% (27 reactors vs. 20). This increase reached 50% (18 vs. 12) among workers with asthma like symptoms. In summary, the inclusion of wheeze detection as outcome measure for MCT allowed the recognition as reactors of subjects that otherwise would be "missed" by spirometry. The resulting increase in the number of true positives improved the sensitivity of MCT to detect AHR in occupationally exposed workers at risk of occupational asthma.
journal_name
Lungjournal_title
Lungauthors
Bohadana AB,Michaely JPdoi
10.1007/s00408-005-2575-ysubject
Has Abstractpub_date
2006-05-01 00:00:00pages
151-7issue
3eissn
0341-2040issn
1432-1750journal_volume
184pub_type
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