Airway responsiveness to inhaled methacholine and to ultrasonically nebulised hyperosmolar saline was compared in 20 asthmatic subjects. Each subject had two hyperosmolar inhalation tests and a methacholine challenge in random order at least 48 hours apart over a period of two weeks. Hyperosmolar challenge, carried out with doubling concentrations of saline from 0.9% to 14.4% to obtain a dose-response curve, was well tolerated by all subjects. The response to hyperosmolar saline--expressed as the PO20, the osmolarity inducing a 20% fall in forced expiratory volume in one second (FEV1) was obtained in 16 of the 20 subjects and in each was repeatable to within one doubling concentration of saline. The peak bronchoconstrictor effect of hyperosmolar saline inhalation occurred at 3 minutes and its mean total duration (FEV1 less than 90% of baseline) was 50 minutes. There was no significant correlation between the PO20 and the PC20 methacholine (the concentration inducing a 20% fall in FEV1). Thus by using a new method to obtain a quantitative airway response to inhaled hyperosmolar saline we found that the airway response to hyperosmolar inhalation differs from the airway response to methacholine.
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