Sánchez-Toril F, Prieto L, Peris R, Pérez J A, Millan M, Marín J
Servicio de Neumologá, Hospital Arnau de Vilanova, Valencia, Spain.
Eur Respir J. 2000 Feb;15(2):260-5. doi: 10.1034/j.1399-3003.2000.15b07.x.
Inhaled acetaldehyde may induce bronchoconstriction in asthmatic subjects and provides a new method to investigate airway responsiveness. The objective of the study was to determine whether acetaldehyde was a more specific stimulus than methacholine in differentiating asthma from chronic bronchitis with or without airflow limitation. Bronchial provocation challenges with methacholine and acetaldehyde were performed in 62 asthmatics and in 59 smokers with chronic bronchitis (32 with chronic bronchitis alone and 27 with chronic bronchitis and coexisting chronic obstructive pulmonary disease (COPD)). The response to both bronchoconstrictor agents was measured by the provocative concentration required to produce a 20% fall in forced expiratory volume in one second (FEV1; PC20). The two types of challenge yielded a similarly high level of sensitivity (100% for methacholine and 92% for acetaldehyde) in revealing airway hyperresponsiveness in asthma. However, bronchoprovocation with acetaldehyde yielded considerably greater specificity (95%) than bronchoprovocation with methacholine (24%) in separating asthma from chronic bronchitis. In subjects with asthma, methacholine and acetaldehyde responsiveness were weakly but significantly correlated (r=0.42, p=0.001) but no correlation was found between airway responsiveness to acetaldehyde and baseline FEV1 (r=0.13, p=0.33). These findings suggest that the demonstration of bronchoconstriction in response to acetaldehyde may be a more specific test than methacholine in the differentiation of asthma from chronic bronchitis. Furthermore, methacholine and acetaldehyde hyperresponsiveness are not reflecting the same pathophysiological process in the airways.
吸入乙醛可能会诱发哮喘患者的支气管收缩，并提供一种研究气道反应性的新方法。本研究的目的是确定在区分哮喘与有或无气流受限的慢性支气管炎时，乙醛是否比乙酰甲胆碱是一种更具特异性的刺激物。对62名哮喘患者和59名患有慢性支气管炎的吸烟者（32名单纯慢性支气管炎患者和27名患有慢性支气管炎并伴有慢性阻塞性肺疾病（COPD）的患者）进行了乙酰甲胆碱和乙醛的支气管激发试验。通过使一秒用力呼气量（FEV1；PC20）下降20%所需的激发浓度来测量对两种支气管收缩剂的反应。在揭示哮喘患者的气道高反应性方面，两种激发试验产生了相似的高敏感性水平（乙酰甲胆碱为100%，乙醛为92%）。然而，在区分哮喘与慢性支气管炎方面，乙醛激发试验的特异性（95%）比乙酰甲胆碱激发试验（24%）高得多。在哮喘患者中，乙酰甲胆碱和乙醛反应性呈弱但显著相关（r = 0.42，p = 0.001），但未发现气道对乙醛的反应性与基线FEV1之间存在相关性（r = 0.13，p = 0.33）。这些发现表明，对乙醛反应的支气管收缩的证明在区分哮喘与慢性支气管炎方面可能是比乙酰甲胆碱更具特异性的试验。此外，乙酰甲胆碱和乙醛高反应性在气道中并未反映相同的病理生理过程。
