Chest
Clinical InvestigationsAirway Responsiveness to Inhaled Histamine in Chronic Obstructive Airways Disease: Chronic Bronchitis vs Emphysema
Section snippets
Subjects
Patients were selected by chart review of outpatients attending the Respiratory Diseases Clinic at the University Hospital in Saskatoon. Twelve patients with COAD and chronic bronchitis were selected. All had long-standing smoking history, irreversible airflow obstruction, normal diffusing capacity, minimal, if any, evidence of vascular deficiency on chest roentgenogram, and chronic cough and sputum. Thirteen patients with COAD and emphysema were selected who had irreversible airflow
RESULTS
Anthropometric and historic data of the 25 patients studied is presented in Table 1. The two groups of patients were comparable with regard to their age, sex, height, weight, and pack-years of smoking. Bronchitis patients had greater cough, sputum, and chronic bronchitis than the emphysema patients. All patients (except one α1-antitrypsin deficient emphysema patient) had a history of heavy smoking. Mean pack-years of smoking for the bronchitis and emphysema patients were 46.9 and 28.3,
DISCUSSION
These data confirm previous work showing the presence of airway hyperresponsiveness in patients with chronic obstructive airways disease and its dependence on the degree of airflow obstruction. Previous work is extended by demonstrating no difference between subject with nonemphysematous COAD with chronic bronchitis and those with emphysematous, nonbronchitis COAD.
Chronic obstructive airways disease (also called chronic obstructive pulmonary disease, chronic obstructive lung disease, chronic
ACKNOWLEDGMENTS
The authors wish to thank Brenda Gore and Jacquie Bramley for their assistance in preparing this manuscript.
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2020, Annals of Allergy, Asthma and ImmunologyAirway Hyperresponsiveness in Asthma: Measurement and Clinical Relevance
2017, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :This is a common reason for poor performance of challenges in epidemiologic studies35 where current is defined as within the past year. Expiratory flows should be normal because airflow obstruction causes (nonasthmatic) responsiveness36,37 due to geometric factors. AHR testing may be of limited use in guiding treatment of cough because a positive test result does not predict response38 and a negative test result does not predict nonresponse39 to asthma therapy.
Direct challenge tests: Airway hyperresponsiveness in asthma: Its measurement and clinical significance
2010, ChestCitation Excerpt :Although it has been attractive (and traditional) to attribute this transient AHR to (eosinophilic) inflammation either directly or indirectly (secondary to mucosal or smooth muscle effects), recent experience with some antiinflammatory therapies, particularly anti-interleukin-5 (mepolizumab), has dissociated AHR and eosinophils.29 The relationship of fixed AHR with structural changes is based on the (nonasthmatic) AHR seen in COPD24,25 and has not been fully validated in asthma. Nevertheless, it does appear, in my view, to relate to asthma duration and to at least a degree of residual airflow obstruction.
Direct and indirect challenges in the clinical assessment of asthma
2009, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :A methacholine challenge is not specific because many patients with rhinitis, other nonasthmatic lung diseases, and even a significant percentage of healthy individuals with no evidence of asthma may have borderline or mild AHR to histamine or methacholine.18 Resting nonasthmatic airflow obstruction, for example in chronic obstructive pulmonary disease, predictably is associated with increased response to direct stimuli, likely a geometric phenomenon.21 Although the positive predictive value in a random population is less than 50%,18 the predictive value of a methacholine PC20 will be greater the lower the number (ie, a methacholine PC20 of 1 mg/mL has a high positive predictive value18) and will be greater with a higher pretest probability for a diagnosis of asthma.5
Mechanisms of airway hyperresponsiveness
2006, Journal of Allergy and Clinical ImmunologyCitation Excerpt :This has been referred to as the pseudoairway hyperresponsiveness of COPD.86 Unlike in asthma, the reduced PC20 has a strong relationship to the reduction in airway caliber102-106 and, for a given FEV1, the airways of COPD patients are much less hyperresponsive than those of patients with asthma.86,104 Subjects with COPD characteristically do not have very much hyperresponsiveness to indirect stimuli.107,108
Influence of lung parenchymal destruction on the different indexes of the methacholine dose-response curve in COPD patients
2000, ChestCitation Excerpt :In the present study, not only were the PC20 for histamine and the PC20 for methacholine correlated with the FEV1 percent predicted, but also with reactivity. The first correlation was reported elsewhere2,89 and was found also by Cheung et al36 and Koyama et al.37 This indicates that the definition of PC20 as a 20% fall of the starting FEV1 makes the outcome highly dependent on measurement of FEV1 in patients with a low FEV1. Our finding that reactivity (the slope of the dose-response curve) is steeper at a lower FEV1 percent predicted, indicates that reactivity also was hampered by the way in which the response is expressed.
Supported by John Moorhead Fellowship Foundation.
Manuscript received January 11; revision accepted March 14.