Parker Annie Lin, Abu-Hijleh Muhanned
Department of Pulmonary and Critical Care Medicine, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA.
Respir Care. 2003 Jun;48(6):596-601.
Airway hyperresponsiveness (AHR) is associated with persistent air flow limitation and accelerated FEV(1) decline. AHR can influence diagnosis, treatment, and prognosis. We assessed the value of pulmonary function variables, symptoms, and history as selection criteria for methacholine bronchoprovocation testing to detect AHR in symptomatic subjects.
Over a 4-year period we conducted a prospective study of consecutive subjects who underwent methacholine bronchoprovocation testing. Baseline pulmonary function testing (PFT) and a questionnaire were obtained prior to methacholine bronchoprovocation testing. PFT and symptom and history variables were assessed as AHR predictors in univariate and multiple logistic regression analyses for the whole group and for 4 different age groups.
There were 530 subjects, with ages ranging from 5 to 87 years, and 232 (44%) were positive for methacholine AHR. AHR was more prevalent among subjects < or = 25 years old (59%) and > 65 years old (47%) than among the other age groups. PFT values, symptom, and history variables had different AHR predictive values among the different age groups. Symptom and history variables had no AHR predictive value among subjects < or = 25 or > 65 years old.
Young and elderly symptomatic subjects are more likely to have methacholine AHR. None of the clinical variables we studied has significant predictive value for methacholine AHR across the age groups, so these variables are poor selection criteria for methacholine bronchoprovocation testing of symptomatic subjects. Given the high prevalence of AHR among these subjects, bronchoprovocation should be considered with all individuals who have respiratory symptoms of wheezing, cough, shortness of breath, or chest tightness.
气道高反应性（AHR）与持续性气流受限及FEV₁加速下降相关。AHR可影响诊断、治疗及预后。我们评估了肺功能变量、症状及病史作为选择标准用于检测有症状受试者中AHR的乙酰甲胆碱支气管激发试验的价值。
在4年期间，我们对连续接受乙酰甲胆碱支气管激发试验的受试者进行了一项前瞻性研究。在乙酰甲胆碱支气管激发试验前获得基线肺功能测试（PFT）及一份问卷。在单因素和多因素逻辑回归分析中，对整个组以及4个不同年龄组评估PFT、症状及病史变量作为AHR预测指标的情况。
共有530名受试者，年龄范围为5至87岁，232名（44%）乙酰甲胆碱AHR呈阳性。AHR在≤25岁（59%）和＞65岁（47%）的受试者中比在其他年龄组中更普遍。PFT值、症状及病史变量在不同年龄组中有不同的AHR预测价值。症状及病史变量在≤25岁或＞65岁的受试者中无AHR预测价值。
年轻和老年有症状受试者更有可能出现乙酰甲胆碱AHR。我们研究的临床变量在各年龄组中对乙酰甲胆碱AHR均无显著预测价值，因此这些变量作为有症状受试者乙酰甲胆碱支气管激发试验的选择标准不佳。鉴于这些受试者中AHR的高患病率，对于所有有喘息、咳嗽、呼吸急促或胸闷等呼吸道症状的个体均应考虑进行支气管激发试验。
