| Indirect challenge tests: Airway hyperresponsiveness in asthma: its measurement and clinical significance. | |
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MedLine Citation:
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PMID: 20668015 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Indirect challenges cause the release of endogenous mediators that cause the airway smooth muscle to contract and the airways to narrow. Airway sensitivity to indirect challenges is reduced or even totally inhibited by treatment with inhaled corticosteroids (ICS), so a positive response to an indirect stimulus is believed to reflect active airway inflammation. The indirect challenges commonly used in pulmonary function laboratories include exercise, eucapnic voluntary hyperpnea, hypertonic (4.5%) saline, and mannitol. Exercise was the first test to be standardized and was used to identify exercise-induced bronchoconstriction (EIB). The inhibition of EIB in young children by sodium cromoglycate led to the concept that mast cells were important very early in the onset of asthma. All of these indirect challenges are associated with the release of mast cell mediators (eg, prostaglandins, leukotrienes, and histamine). The hypertonic saline and mannitol challenges arose from the concept that EIB was caused by an increased osmolarity of the airway surface with release of mediators. These osmotic aerosols simplified testing with indirect challenges in the laboratory, improving the potential to identify currently active asthma. Although hyperresponsiveness to indirect challenges is frequently associated with a sputum eosinophilia, it is not a prerequisite because the mast cell is the most important source of mediators. The mechanism for ICS reducing hyperresponsiveness to indirect challenges likely involves both mast cells and eosinophils. Indirect challenges are appropriate to inform further on both the pathogenesis of asthma and the role of antiinflammatory agents in its treatment. |
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Authors:
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Sandra D Anderson |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Chest Volume: 138 ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-29 Completed Date: 2010-09-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: 25S-30S Citation Subset: AIM; IM |
Affiliation:
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Royal Prince Alfred Hospital, Department of Respiratory and Sleep Medicine, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia. sandra.anderson@sydney.edu.au |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Asthma
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blood,
diagnosis*,
physiopathology Biological Markers / blood* Bronchial Hyperreactivity / physiopathology* Bronchial Provocation Tests / methods* Bronchoconstriction / physiology* Exercise Test / methods* Histamine / blood Humans Methacholine Chloride / blood Reproducibility of Results Severity of Illness Index |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 51-45-6/Histamine; 62-51-1/Methacholine Chloride |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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