천식 소아에서 아토피와 간접유발 기관지과민성과의 연관성 = Relationship between atopy and bronchial hyperresponsiveness to indirect stimuli in asthmatic children

다국어 초록 (Multilingual Abstract)

Purpose: Both atopy and bronchial hyperresponsiveness (BHR) are characteristic features of asthma. Several BHR studies comparing groups of atopic and nonatopic asthmatics have reported conflicting results. The aim of this study was to compare BHR to indirect stimuli, such as mannitol or exercise, between atopic and nonatopic asthmatics in children Methods: We performed a retrospective analysis of data from 110 children with asthma, aged 6-18 years using skin prick tests, and serum total and specific IgE levels. Atopy degree was measured using the sum of graded wheal size or the sum of the allergen-specific IgE. Bronchial provocation tests (BPTs) using methacholine were performed on all subjects. BPTs using indirect simuli, including exercise and mannitol, were also performed. Results: Asthma cases were classified as atopic asthma (n=83) or nonatopic asthma (n=27) from skin prick or allergen-specific IgE test results. There was no significant difference in the prevalence of BHR to mannitol or exercise between atopic and nonatopic asthmatics. Atopic asthma had a significantly lower postexercise maximum decrease in % forced expiratory volume in 1 second (FEV₁) (geometric mean [95% confidence interval]: 31.9 [22.9-40.9] vs. 14.0 [9.4-18.6], P=0.015) and a methacholine PC₂₀ (provocative concentration of methacholine inducing a 20% fall in FEV₁) than nonatopic asthmatics (geometric mean [95% confidence interval]: 1.24 [0.60-1.87] ng/mL vs. 4.97 [3.47-6.47]) ng/mL, P=0.001), whereas mannitol PD₁₅ (cumulative provocative dose causing a 15% fall in FEV₁) was not significantly different between the 2 groups. Conclusion: There was no significant difference in the prevalence of BHR to mannitol or exercise between atopic and nonatopic asthmatics in children. (Allergy Asthma Respir Dis 2017:5:83-91)

참고문헌 (Reference)

1 Koh YY, "Systematic understanding of bronchial asthma: focusing on childhood asthma" Seoul National University Press 274-300, 2013

2 Chai H, "Standardization of bronchial inhalation challenge procedures" 56 : 323-327, 1975

3 Miller MR, "Standardisation of spirometry" 26 : 319-338, 2005

4 Yoshikawa T, "Severity of exercise-induced bronchoconstriction is related to airway eosinophilic inflammation in patients with asthma" 12 : 879-884, 1998

5 김지현, "Sensitization to Aeroallergens in Korean Children: A Populationbased Study in 2010" 대한의학회 26 (26): 1165-1172, 2011

6 Brannan JD, "Responsiveness to mannitol in asthmatic subjects with exercise- and hyperventilation-induced asthma" 158 : 1120-1126, 1998

7 Steerenberg PA, "Relationship between exhaled NO, respiratory symptoms, lung function, bronchial hyperresponsiveness, and blood eosinophilia in school children" 58 : 242-245, 2003

8 Porsbjerg C, "Relationship between airway responsiveness to mannitol and to methacholine and markers of airway inflammation, peak flow variability and quality of life in asthma patients" 38 : 43-50, 2008

9 Covar RA, "Relations between exhaled nitric oxide and measures of disease activity among children with mild-to-moderate asthma" 142 : 469-475, 2003

10 Hallstrand TS, "New insights into pathogenesis of exercise-induced bronchoconstriction" 12 : 42-48, 2012

11 Suh DI, "Methacholine and adenosine 5'-monophosphate (AMP) responsiveness, and the presence and degree of atopy in children with asthma" 22 (22): e101-e106, 2011

12 Brannan JD, "Inhibition of mast cell PGD2 release protects against mannitol-induced airway narrowing" 27 : 944-950, 2006

13 Hallstrand TS, "Inflammatory basis of exercise-induced bronchoconstriction" 172 : 679-686, 2005

14 Anderson SD, "Indirect challenge tests: Airway hyperresponsiveness in asthma: its measurement and clinical significance" 138 (138): 25S-30S, 2010

15 Crapo RO, "Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999" 161 : 309-329, 2000

16 Bateman ED, "Global strategy for asthma management and prevention: GINA executive summary" 31 : 143-178, 2008

17 Harmanci K, "Factors affecting bronchial hyperreactivity in asthmatic children" 45 : 730-734, 2008

18 Cardinale F, "Exhaled nitric oxide, total serum IgE and allergic sensitization in childhood asthma and allergic rhinitis" 16 : 236-242, 2005

19 Brannan JD, "Evidence of mast cell activation and leukotriene release after mannitol inhalation" 22 : 491-496, 2003

20 Lee SY, "Eosinophils play a major role in the severity of exercise-induced bronchoconstriction in children with asthma" 41 : 1161-1166, 2006

21 Lúdvíksdóttir D, "Different airway responsiveness profiles in atopic asthma, nonatopic asthma, and Sjögren's syndrome. BHR Study Group. Bronchial hyperresponsiveness" 55 : 259-265, 2000

22 Jatakanon A, "Correlation between exhaled nitric oxide, sputum eosinophils, and methacholine responsiveness in patients with mild asthma" 53 : 91-95, 1998

23 Anderson SD, "Comparison of mannitol and methacholine to predict exercise-induced bronchoconstriction and a clinical diagnosis of asthma" 10 : 4-, 2009

24 Kurukulaaratchy RJ, "Characterisation of atopic and non-atopic wheeze in 10 year old children" 59 : 563-568, 2004

25 Hargreave FE, "Bronchial responsiveness to histamine or methacholine in asthma: measurement and clinical significance" 68 : 347-355, 1981

26 Castro-Rodriguez JA, "Bronchial hyperreactivity to methacholine in atopic versus nonatopic asthmatic schoolchildren and preschoolers" 47 : 929-934, 2010

27 Ferrante E, "Associations between atopy, asthma history, respiratory function and non-specific bronchial hyperresponsiveness in unselected young asthmatics" 59 : 169-172, 1992

28 Currie GP, "Allergen sensitization and bronchial hyper-responsiveness to adenosine monophosphate in asthmatic patients" 33 : 1405-1408, 2003

29 Hallstrand TS, "Airway immunopathology of asthma with exercise-induced bronchoconstriction" 116 : 586-593, 2005

30 American Thoracic Society, "ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005" 171 : 912-930, 2005