Document Detail

Indirect airway challenges.
MedLine Citation:
PMID:  12797503     Owner:  NLM     Status:  MEDLINE    
Indirect challenges act by causing the release of endogenous mediators that cause the airway smooth muscle to contract. This is in contrast to the direct challenges where agonists such as methacholine or histamine cause airflow limitation predominantly via a direct effect on airway smooth muscle. Direct airway challenges have been used widely and are well standardised. They are highly sensitive, but not specific to asthma and can be used to exclude current asthma in a clinic population. Indirect bronchial stimuli, in particular exercise, hyperventilation, hypertonic aerosols, as well as adenosine, may reflect more directly the ongoing airway inflammation and are therefore more specific to identify active asthma. They are increasingly used to evaluate the prevalence of bronchial hyperresponsiveness and to assess specific problems in patients with known asthma, e.g. exercise-induced bronchoconstriction, evaluation before scuba diving. Direct bronchial responsiveness is only slowly and to a modest extent, influenced by repeated administration of inhaled steroids. Indirect challenges may reflect more closely acute changes in airway inflammation and a change in responsiveness to an indirect stimulus may be a clinically relevant marker to assess the clinical course of asthma. Moreover, some of the indirect challenges, e.g. hypertonic saline and mannitol, can be combined with the assessment of inflammatory cells by induction of sputum.
G F Joos; B O'Connor; S D Anderson; F Chung; D W Cockcroft; B Dahlén; G DiMaria; A Foresi; F E Hargreave; S T Holgate; M Inman; J Lötvall; H Magnussen; R Polosa; D S Postma; J Riedler;
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Publication Detail:
Type:  Guideline; Journal Article; Practice Guideline    
Journal Detail:
Title:  The European respiratory journal     Volume:  21     ISSN:  0903-1936     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-06-11     Completed Date:  2003-10-03     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  1050-68     Citation Subset:  IM    
Dept Respiratory Diseases, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
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MeSH Terms
Asthma / complications,  diagnosis*,  physiopathology
Bronchial Provocation Tests / adverse effects,  standards*,  trends
Physical Stimulation / adverse effects
Physician's Practice Patterns / standards*,  trends
Reproducibility of Results
Respiratory Function Tests / adverse effects,  standards*,  trends
Respiratory System / drug effects,  physiopathology
Stimulation, Chemical
Erratum In:
Eur Respir J. 2003 Oct;22(4):718

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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