천식경과 중 메타콜린 검사 음성화 전환 환자군의 임상적 특성

박세미 ( Se Mi Park ),이용원 ( Yong Won Lee ),박중원 ( Jung Won Park ),홍천수 ( Chein Soo Hong ) 대한천식알레르기학회 2008 천식 및 알레르기 Vol.28 No.1

Background: Clinical characteristics of asthmatics undergoing negative conversion of bronchial hyperreactivity in the methacholine bronchial provocation test (M-test) were not completely evaluated yet. We investigated clinical characteristics of negative conversion of bronchial hyperreactivity in asthmatics. Method: We enrolled 57 patients who were treated more than 1 year at our clinic. We compared parameters of clinical data and the PC20 results of the pulmonary function test and M-test between the negative conversion group (NCG) of bronchial hyperreactivity and the control group with persistent bronchial hyperreactivity (CG). Result: Thirty of the 57 asthmatics showed negative conversion of bronchial hyperreactivity in the M-tests and included in NCG. The remaining 27 patients were included in the CG. There were no significant differences in sex, age, smoking history, atopic sensitization and the initial severity of asthma between the NCG and CG. The initial PC20 of the CG (1.31±2.03 mg/mL) was not significantly different from that of NCG (2.34±4.36 mg/mL) either. The mean treatment duration until negative conversion of bronchial hyperreactivity was 5.46±4.28 years. The initial TEC of the NCG (399.29±250.66 /mcL) was lower than that of the CG (608.92±371.74 /mcL)(P=0.018). Eosinophils in induced sputum (%) of the NCG (22.23±21.63%) was also lower than that of the CG (40.85±32.07%)(P=0.021). The initial FEV1 was higher in the NCG (86.06±15.96%) than in the CG (72.37±18.40%)(p=0.004). FEV1/FVC was also higher in the NCG (76.54±9.59%) than in the CG (65.43±11.14)(P<0.001). QOL scores were not significantly different between both groups. Conclusion: The negative conversion group of bronchial hyperreactivity may show better pulmonary functions and milder eosinophilic inflammation. (Korean J Asthma Allergy Clin Immunol 2008;28:20-25)

Nonspecific Bronchoprovocation Test

Lee, Myoung Kyu,Yoon, Hyoung Kyu,Kim, Sei Won,Kim, Tae-Hyung,Park, Seoung Ju,Lee, Young Min The Korean Academy of Tuberculosis and Respiratory 2017 Tuberculosis and Respiratory Diseases Vol.80 No.4

Bronchial asthma is a disease characterized by the condition of airway hyper-responsiveness, which serves to produce narrowing of the airway secondary to airway inflammation and/or various spasm-inducing stimulus. Nonspecific bronchoprovocation testing is an important method implemented for the purpose of diagnosing asthma; this test measures the actual degree of airway hyper-responsiveness and utilizes direct and indirect bronchoprovocation testing. Direct bronchoprovocation testing using methacholine or histamine may have superior sensitivity as these substances directly stimulate the airway smooth muscle cells. On the other hand, this method also engenders the specific disadvantage of relatively low specificity. Indirect bronchoprovocation testing using mannitol, exercise, hypertonic saline, adenosine and hyperventilation serves to produce reactions in the airway smooth muscle cells by liberating mediators with stimulation of airway inflammatory cells. Therefore, this method has the advantage of high specificity and also demonstrates relatively low sensitivity. Direct and indirect testing both call for very precise descriptions of very specific measurement conditions. In addition, it has become evident that challenge testing utilizing each of the various bronchoconstrictor stimuli requires distinct and specific protocols. It is therefore important that the clinician understand the mechanism by which the most commonly used bronchoprovocation testing works. It is important that the clinician understand the mechanism of action in the testing, whether direct stimuli (methacholine) or indirect stimuli (mannitol, exercise) is implemented, when the testing is performed and the results interpreted.

Nonspecific Bronchoprovocation Test

( Myoung Kyu Lee ),( Hyoung Kyu Yoon ),( Sei Won Kim ),( Tae-hyung Kim ),( Seoung Ju Park ),( Young Min Lee ) 대한결핵 및 호흡기학회 2017 Tuberculosis and Respiratory Diseases Vol.80 No.4

Bronchial asthma is a disease characterized by the condition of airway hyper-responsiveness, which serves to produce narrowing of the airway secondary to airway inflammation and/or various spasm-inducing stimulus. Nonspecific bronchoprovocation testing is an important method implemented for the purpose of diagnosing asthma; this test measures the actual degree of airway hyper-responsiveness and utilizes direct and indirect bronchoprovocation testing. Direct bronchoprovocation testing using methacholine or histamine may have superior sensitivity as these substances directly stimulate the airway smooth muscle cells. On the other hand, this method also engenders the specific disadvantage of relatively low specificity. Indirect bronchoprovocation testing using mannitol, exercise, hypertonic saline, adenosine and hyperventilation serves to produce reactions in the airway smooth muscle cells by liberating mediators with stimulation of airway inflammatory cells. Therefore, this method has the advantage of high specificity and also demonstrates relatively low sensitivity. Direct and indirect testing both call for very precise descriptions of very specific measurement conditions. In addition, it has become evident that challenge testing utilizing each of the various bronchoconstrictor stimuli requires distinct and specific protocols. It is therefore important that the clinician understand the mechanism by which the most commonly used bronchoprovocation testing works. It is important that the clinician understand the mechanism of action in the testing, whether direct stimuli (methacholine) or indirect stimuli (mannitol, exercise) is implemented, when the testing is performed and the results interpreted.

Nonspecific Bronchoprovocation Test

이명규,윤형규,김세원,김태형,박성주,이영민 대한결핵및호흡기학회 2017 Tuberculosis and Respiratory Diseases Vol.80 No.4

Bronchial asthma is a disease characterized by the condition of airway hyper-responsiveness, which serves to produce narrowing of the airway secondary to airway inflammation and/or various spasm-inducing stimulus. Nonspecific bronchoprovocation testing is an important method implemented for the purpose of diagnosing asthma; this test measures the actual degree of airway hyper-responsiveness and utilizes direct and indirect bronchoprovocation testing. Direct bronchoprovocation testing using methacholine or histamine may have superior sensitivity as these substances directly stimulate the airway smooth muscle cells. On the other hand, this method also engenders the specific disadvantage of relatively low specificity. Indirect bronchoprovocation testing using mannitol, exercise, hypertonic saline, adenosine and hyperventilation serves to produce reactions in the airway smooth muscle cells by liberating mediators with stimulation of airway inflammatory cells. Therefore, this method has the advantage of high specificity and also demonstrates relatively low sensitivity. Direct and indirect testing both call for very precise descriptions of very specific measurement conditions. In addition, it has become evident that challenge testing utilizing each of the various bronchoconstrictor stimuli requires distinct and specific protocols. It is therefore important that the clinician understand the mechanism by which the most commonly used bronchoprovocation testing works. It is important that the clinician understand the mechanism of action in the testing, whether direct stimuli (methacholine) or indirect stimuli (mannitol, exercise) is implemented, when the testing is performed and the results interpreted.

Dyspnea Perception During Induced Bronchoconstriction Is Complicated by the Inhaled Methacholine in Children With Clinical Asthma

Choi, Yun Jung,Suh, Dong In,Sohn, Myung Hyun,Koh, Young Yull The Korean Academy of Asthma, Allergy and Clinical 2018 Allergy, Asthma & Immunology Research Vol.10 No.2

<P><B>Purpose</B></P><P>Dyspnea is not widely utilized as an indicator of asthma provocation despite its universal presentation. We hypothesized that dyspnea severity was proportionate with the lung function decline, methacholine dose-step, and the degree of bronchial hyperresponsiveness (BHR).</P><P><B>Methods</B></P><P>We retrospectively analyzed 73 children's bronchial provocation test data with an assessment of dyspnea at every dose-step. Dyspnea severity was scored using a modified Borg (mBorg) scale. A linear mixed effect analysis was performed to evaluate the relationship between the mBorg scale, the percentage fall in the forced expiratory volume in 1 second (FEV1) (ΔFEV1%), the methacholine dose-step, and the degree of BHR (BHR grade).</P><P><B>Results</B></P><P>Subjects were divided into 5 BHR groups based on their last methacholine dose-steps. The mBorg scores did not differ significantly among BHR groups (<I>P</I>=0.596, Kruskal-Wallis test). The linear mixed effect analysis showed that ΔFEV1% was affected by the methacholine dose-step (<I>P</I><0.001) and BHR grade (<I>P</I><0.001). The mBorg score was affected by the dose-step (<I>P</I><0.001) and BHR grade (<I>P</I>=0.019). We developed a model to predict the mBorg score and found that it was affected by the methacholine dose-step and ΔFEV1%, elevating it by a score of 0.039 (χ<SUP>2</SUP> [1]=21.06, <I>P</I><0.001) and 0.327 (χ<SUP>2</SUP> [1]=47.45, <I>P</I><0.001), respectively. A significant interaction was observed between the methacholine dose-step and ΔFEV1% (χ<SUP>2</SUP> [1]=16.20, <I>P</I><0.001).</P><P><B>Conclusions</B></P><P>In asthmatic children, inhaled methacholine, as well as the degree of BHR and lung function decline, may affect dyspnea perception during the bronchial provocation test. If we wish to draw meaningful information from dyspnea perception, we have to consider various complicating factors underlying it.</P>

The Lung Function Impairment in Non-Atopic Patients With Chronic Rhinosinusitis and Its Correlation Analysis

Linghao Zhang,Lu Zhang,Chun-Hong Zhang,Xiao-Bi Fang,Zhen-Xiao Huang,Qing -Yuan Shi,Li-Ping Wu,Peng Wu,Zhen-Zhen Wang,Zhi-Su Liao 대한이비인후과학회 2016 Clinical and Experimental Otorhinolaryngology Vol.9 No.4

Objectives. Chronic rhinosinusitis (CRS) is common disease in otorhinolaryngology and will lead to lower airway abnormality. However, the only lung function in CRS patients and associated factors have not been much studied. Methods. One hundred patients with CRS with nasal polyps (CRSwNP group), 40 patients with CRS without nasal polyps (CRSsNP group), and 100 patients without CRS were enrolled. The difference in lung function was compared. Meanwhile, CRSwNP and CRSsNP group were required to undergo a bronchial provocation or dilation test. Additionally, subjective and objective outcomes were measured by the visual analogue scale (VAS), 20-item Sino-Nasal Outcome Test (SNOT-20), Lund-Mackay score, Lund-Kennedy endoscopic score. The correlation and regression methods were used to analyze the relationship between their lung function and the above parameters. Results. The forced expiratory volume in 1 second (FEV1) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) of CRSwNP group were significantly lower than other groups (P<0.05). On peak expiratory flow, there was no difference between three groups. In CRSwNP group, FEV1 was negatively correlated with peripheral blood eosinophil count (PBEC) and duration of disease (r=–0.348, P=0.013 and r=–0.344, P=0.014, respectively), FEF25-75 negatively with VAS, SNOT-20 (r=–0.490, P=0.028 and r=–0.478, P=0.033, respectively) in CRSsNP group. The incidence of positive bronchial provocation and dilation test was lower in CRSwNP group (10% and 0%, respectively), with both 0% in CRSsNP group. The multiple linear regression analysis indicated that change ratio of FEV1 before and after bronchial provocation or dilation test were correlated with PBEC in CRSwNP group (β=0.403, P=0.006). Conclusion. CRS leading to impaired maximum ventilation and small airway is associated with the existence of nasal polyp. Lung function impairments can be reflected by PBEC, duration, VAS, and SNOT-20. In CRSwNP patients, PBEC is independent predictor of FEV1 change ratio.

Oral provocation tests with aspirin and food additives in asthmatic patients

Hong, Sung Pyo,Park, Hae Sim,Lee, Mi Kyung,Hong, Chein-Soo Yonsei University, College of Medicine 1989 Yonsei medical journal Vol.30 No.4

임상적 천식 소아에서 기관지유발시험 중 관찰되는 두 호흡곤란 지표의 특성 비교

김유선 ( You Sun Kim ),신정민 ( Jeongmin Shin ),최윤정 ( Yun Jung Choi ),송준혁 ( Jun-hyuk Song ),이주경 ( Ju Kyung Lee ),오혜린 ( Hea Lin Oh ),서동인 ( Dong In Suh ),고영률 ( Young Yull Koh ) 대한천식알레르기학회 2017 Allergy Asthma & Respiratory Disease Vol.5 No.5

Purpose: Dyspnea is the cardinal symptom of asthma, but it is difficult to quantify clinically. Although modified Borg (mBorg) scale has been successfully used in adult, but there has been some difficulties to apply in children. Recently, Pediatric Dyspnea Scale (PDS) was adequately designed and has been widely used. The aim of this study is to compare 2 evaluating scales of dyspnea provoked by induced-bronchoconstriction in childhood asthma. Methods: Seventy-three clinically suspected children with asthma were enrolled in this study. Each ‘fractional exhaled nitric oxide (FeNO)’ was documented. Forced expiratory volume in 1 second (FEV₁), mBorg score and PDS score were recorded during metha-choline provocation test. Results: Mapping using canonical plot demonstrated global similarity between 2 scales with some distinctive features. Whereas mBorg score showed more diverse categories in low level of dyspnea, PDS score did in medium level of it. A distribution of dyspnea perception score at a 20% decrease in FEV₁ relative to baseline (PS₂₀), a perception score of dyspnea at 20% fall in FEV1 of 2 scales represented similar wide, biphasic feature. Statistical relevance was verified with spearman correlation (R_s=0.903, P<0.001) and Bland-Altman analysis. PS₂₀ of both scores and FeNO had no statistical relationship. While relationship between PS₂₀ by mBorg score and the concentration of methacholine at 20% fall in FEV1 (PC₂₀) was not significant (R_s=0.224, P=0.154), that between PS₂₀ by PDS and PC₂₀ was weak positive (R_s=0.29, P=0.063). Conclusion: PDS had similar pattern to assess the dyspnea with the mBorg scale suggesting adequacy of PDS in evaluating pediat-ric clinical asthma. We expect these scales to help clinical practice in complementary ways. (Allergy Asthma Respir Dis 2017;5:262-268)

기관지 천식, 알레르기성 비염 및 만성기침 환자에서 메타콜린 유발검사 성적

윤종수,현상훈,남언정,김건우,강천일,서영익,이종명,김능수 慶北大學校 醫科大學 1996 慶北醫大誌 Vol.37 No.3

목적 : 비특이적 기관지과민증은 기관지천식 환자외에도 알레르기성 비염과 만성기침 환자의 일부에서 양성반응을 보이는 것으로 알려져 있다. 저자들은 기관지천식, 알레르기성 비염 및 만성기침 환자에서 기관지과민증의 정도 및 이에 영향을 미치는 인자를 조사하였다. 대상 및 방법 : 기관지천식 환자 135명, 알레르기성 비염 환자 56명, 만성기침 환자 54명을 대상으로 하여 폐기능 검사, 메타콜린 유발검사, 각종 알레르기 검사 등의 성적을 후향적으로 분석하였다. 결과 : 기관지천식 환자의 87.4%, 알레르기성 비염 환자의 19.6%, 만성기침 환자의 20.4%에서 기관지과민증이 관찰되었다. 기관지과민증은 천식 환자의 경우 기저 FEV_1 및 질병 이환기간과 각각양의 유의성 및 음의 유의성을 보였으며 중증인 천식 환자군에서 과민증이 더 현저하였다. 만성기침환자의 경우 메타콜린 양성인 군에서 질병 이환기간이 다소 짧았지만, 알레르기성 비염과 만성기침 환자군 모두에서 유의한 차이를 보이는 다른 변수는 없었다. 결론 : 기관지과민증은 기관지천식 환자의 대다수에서 관찰되며 이는 기저 폐기능, 천식 이환기간 및 천식의 증상 정도와 관련이 있었다. 또한 알레르기성 비염 및 만성기침 환자의 약 20%에서 기관지과민증이 동반되었으나 이를 예측할 수 있는 의미 있는 지표는 발견할 수 없었다. One of the characteristic features of bronchial asthma (BA) is the presence of bronchial hyperresponsiveness to physical, chemical, and pharmacological stimuli. But nonspecific bronchial hyperresponsiveness is also noted in some patients with allergic rhinitis (AR) and chronic cough (CC) who have experienced no dyspnea or wheeze. In order to find the prevalence of bronchial hyperresponsiveness and factors predicting its presence, we analyzed retrospectively the clinical and laboratory data of 135 patients with BA, 56 patients with AR and 54 patients with CC. The following results were obtained : 1) Response to methacholine bronchial provocation test (MBPT) was positive (PC_20≤25㎎/㎖) in 118 out of 135 BA (87.4%). 11 out of 56 AR (19.6%) and 11 out of 54 CC (20.4%). 2) Baseline FEV_1 and FEV_1/FVC(%) were significantly lower in MBPT positive BA group than those of negative group, but there was no significant difference in other variables. 3) Positive correlation between the baseline FEV_1 and methacholine logPC_20 (P=0.003) and negative correlation between the disease duration and methacholine logPC_20 (P=0.01) were noted in MBPT positive BA. And severe asthma group had lower logPC_20 values than mild and moderate asthma group (P=0.017). 4) Though MBPT positive CC group had shorter disease duration, there were no other significant variables predicting the presence of bronchial hyperresponsiveness in AR and CC. In conclusion, bronchial hyperresponsiveness existed in most BA patients and in about 20% of patients with AR or CC. It was related to pulmonary function and disease duration in BA, but there were no significant variables predicting its presense in AR and CC.

기관지유발검사 시행과 해석: 전문가 의견서

임경환,김민혜,양민석,송우정,정재우,이정민,서동인,신유섭,권재우,김세훈,김상헌,이병재,조상헌,대한천식알레르기학회 표준화위원회 대한 소아알레르기 호흡기학회 2018 Allergy Asthma & Respiratory Disease Vol.6 No.1

Bronchial provocation tests are of value in the evaluation of airway hyperresponsiveness. Nonspecific bronchial challenge (methacholine, mannitol, exercise, etc.) is used when the symptoms, physical examination, and measurements of pulmonary function are unremarkable in the diagnosis of asthma, when a patient is suspected of having occupational asthma or exercise-induced bronchoconstriction (EIB), and when a screening test for asthma or EIB is required for some occupational groups in whom bronchospasm would pose an unacceptable hazard. Methacholine inhalation challenge is most widely used pharmacologic challenge and highly sensitive. For appropriate interpretation of the results of methacholine provocation, it is important to perform the test with the standardized protocol and to recognize that inhalation methods significantly influence the sensitivity of the procedure. Indirect challenges (e.g., mannitol and exercise) correlate with airway inflammation and are more specific but less sensitive for asthma. Indirect provocation tests are used to confirm asthma, to differentiate asthma from other airway diseases, and to evaluate EIB.