Document Detail

Methacholine vs adenosine on intra and extrathoracic airway hyperresponsiveness in patients with cough variant asthma.
MedLine Citation:
PMID:  18394126     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Airway hyperresponsiveness (AHR) can be studied by bronchoprovocation test (BPT) using direct (methacholine - MCh) or indirect (adenosine 5'-monophosphate - AMP) stimuli. These two substances have not been compared in cough variant asthma (CVA). OBJECTIVE: We designed a randomized, single-blind, cross-over study to compare AMP and MCh in the detection of CVA. Additionally, we examined whether assessment of extrathoracic airway hyperresponsiveness (EAHR) during MCh and AMP helped in the evaluation of CVA. METHODS: Patients with CVA with previous positive MCh BPT performed challenges with AMP and MCh. The variables were: (i) a provocative dose producing a 20% fall in forced expiratory volume in 1 s (FEV(1)) value (PD(20)MCh); (ii) a provocative dose producing a 25% fall in the maximal mid-inspiratory flow (FIF(50)) from baseline (PD(25)MCh) for MCh; (iii) a provocative concentration producing a 20% fall in FEV(1) value (PC(20)AMP) and (iv) a provocative concentration producing a 25% fall in the FIF(50) from baseline (PC(25)AMP) for AMP. RESULTS: All 113 patients with CVA responded to PD(20)MCh and 96% and 69% responded to PC(20)AMP, if we used PC(20) </= 200 mg/ml or PC(20) </= 100 mg/ml, respectively, with an excellent correlation between these two tests (r = 0.87 and 0.76, respectively). Extrathoracic AHR associated with AHR was found in 10% in MCh challenge and in 11% with AMP challenge and no patients had EAHR alone. CONCLUSION: Adenosine challenges correlate well with MCh in patients with CVA. A minority (c. 10%) of CVA patients have EAHR as measured by these tests, while most had AHR as assessed with each of the challenge agents.
M Ribeiro; C A C Pereira; L E Nery; O S Beppu; C O S Silva
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Allergy     Volume:  63     ISSN:  1398-9995     ISO Abbreviation:  Allergy     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-08     Completed Date:  2008-05-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7804028     Medline TA:  Allergy     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  527-32     Citation Subset:  IM    
Respiratory Division, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
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MeSH Terms
Adenosine Monophosphate / diagnostic use*
Asthma / diagnosis,  physiopathology
Bronchi / drug effects
Bronchial Hyperreactivity / diagnosis*
Bronchial Provocation Tests
Cough / physiopathology*
Cross-Over Studies
Methacholine Chloride / diagnostic use*
Middle Aged
Respiratory Function Tests
Reg. No./Substance:
61-19-8/Adenosine Monophosphate; 62-51-1/Methacholine Chloride

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