Cockcroft D W
Royal University Hospital, Saskatoon, Canada.
Can Respir J. 2000 Mar-Apr;7(2):182-7. doi: 10.1155/2000/846798.
The present paper revisits the 1977 paper by DW Cockcroft, RE Ruffin, the late J Dolovich and FE Hargreave entitled "Allergen-induced increase in nonallergic bronchial reactivity" (Clin Allergy 1977;7:503-13) that became a citation classic. Although clinical types of asthma were recognized at the time, there was a poor understanding regarding the role of allergic reactions in causing increases in airway hyperresponsiveness. The objective was to study formally Dr Altounyan's observation that patients with asthma showed increases in airway responsiveness at the times of natural allergen exposure during pollen season. Thirteen atopic patients with asthma were studied over two days, following inhalation of diluent (control) and following doubling amounts of an allergen solution at 10-min intervals until forced expiration volume in 1 s fell by 20%. Methacholine and histamine challenges were performed before, at 8 h, at 32 h and seven days following the inhalations. A significant reduction (reduction of at least one doubling concentration) in the provocative concentration that causes a 20% fall in forced expiration volume in 1 s occurred in seven of 13 patients, and more often in subjects with a late bronchoconstrictor response to allergen challenge.
The study showed that large changes in airway responsiveness could occur in patients with asthma and suggested that allergens could cause, rather than trigger, asthma. The study also led to the concept of asthma inducers and inciters - inducers causing airway inflammation and inciters provoking bronchospasm. The results led to a series of observations that have now implicated immunoglobulin E-mediated airway inflammation as perhaps the most important cause of airway hyperresponsiveness in asthma.
本文重新审视了DW·科克罗夫特、RE·鲁芬、已故的J·多洛维奇和FE·哈格里夫斯于1977年发表的题为《变应原诱导的非变应性支气管反应性增加》（《临床变态反应》1977年；7:503 - 13）的论文，该论文已成为被广泛引用的经典之作。尽管当时已认识到哮喘的临床类型，但对于变应性反应在导致气道高反应性增加中所起的作用了解甚少。其目的是正式研究阿尔图尼扬医生的观察结果，即哮喘患者在花粉季节自然接触变应原时气道反应性会增加。对13名特应性哮喘患者进行了为期两天的研究，先吸入稀释剂（对照），然后每隔10分钟吸入剂量加倍的变应原溶液，直至1秒用力呼气量下降20%。在吸入前、吸入后8小时、32小时和7天进行乙酰甲胆碱和组胺激发试验。13名患者中有7名患者使1秒用力呼气量下降20%的激发浓度显著降低（至少降低一个加倍浓度），且在对变应原激发试验有迟发性支气管收缩反应的受试者中更常见。
该研究表明哮喘患者的气道反应性可能发生巨大变化，并提示变应原可导致而非触发哮喘。该研究还引出了哮喘诱导因素和激发因素的概念——诱导因素引起气道炎症，激发因素引发支气管痉挛。这些结果引发了一系列观察结果，现已表明免疫球蛋白E介导的气道炎症可能是哮喘气道高反应性的最重要原因。
