Chest
Airway Hyperresponsiveness in Asthma: Its Measurement and Clinical SignificanceIndirect Challenge Tests: Airway Hyperresponsiveness in Asthma: Its Measurement and Clinical Significance
Section snippets
Exercise as a Test of Bronchial Hyperresponsiveness
Exercise was the first indirect challenge test to be standardized.5 It was developed because the mast cell-stabilizing drug sodium cromoglycate (SCG) could not be evaluated for asthma using either a histamine or a methacholine challenge. Allergen, the indirect challenge being used at the time, was considered inappropriate because of its potential to cause a late asthmatic response. Exercise is a common stimulus for provoking bronchoconstriction, and guidelines usually include exercise tolerance
Surrogates for Identifying BHR to Inflammatory Mediators of EIB
The EVH test breathing dry air (∼5% CO2, 21% oxygen, balance nitrogen) for 6 min at a ventilation target of 30 × FEV1 was initially standardized to evaluate army recruits for asthma16 and later to identify EIB in elite athletes.17 Field exercise at 2°C was compared with EVH in the laboratory at 19.4°C and responses were found to be equivalent for most winter athletes.18 EVH can provoke severe falls in FEV1, so its use is confined to evaluate those who regularly exercise at high intensities. The
Interpretation of a Mannitol Test Result
Mannitol is used to assess BHR to aid in the diagnosis of asthma. A positive test result to mannitol is consistent with the presence of inflammatory cells (eg, eosinophils and/or mast cells) and their mediators (eg, prostaglandins, leukotrienes, and histamine). Therefore, mannitol is most useful as a test to confirm a diagnosis of currently active asthma in a treated or untreated subject.32, 33 This gives it an advantage over methacholine. Methacholine is also indicated for the diagnosis of BHR
Acknowledgments
Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Anderson is the inventor of the mannitol test. The patent is owned by her employer, Sydney South West Area Health Service (SSWAHS). SSWAHS invoiced Pharmaxis for her time until March 2009. She has not received monies from Pharmaxis other than to cover traveling expenses. Since March 2009, she has received consulting fees. She own shares in Pharmaxis that she purchased herself. She does
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