Manso Luis, Madero Mauro F, Ruiz-García Mónica, Fernández-Nieto Mar, Sastre Joaquín
Allergy Department, Fundación Jiménez Díaz and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
J Asthma. 2011 May;48(4):335-40. doi: 10.3109/02770903.2011.565850.
Bronchial hyperresponsiveness is usually measured by bronchial challenge test with direct (e.g., methacholine) and indirect (e.g., adenosine) agonists. There are few studies comparing both types of agents and they have had conflicting concordance.
We sought to compare the results of both tests in a population with symptoms suggestive of asthma so as to determine their relationship with bronchial inflammatory markers.
Seventy-nine patients whose age ranged from 14 to 81 years were recruited for this study. Challenge tests were performed using the tidal volume method. PC₂₀ methacholine and PC₁₅ and PC₂₀ adenosine were calculated. Induced sputum and fraction of exhaled nitric oxide measurements were also performed.
Atopy was found in 69% of the patients. Methacholine PC₂₀ and adenosine PC₁₅ were positive in 32 patients (40.5%), both having a sensitivity of 73%. Percentage of agreement was 45.45% and κ index was only 0.369. Adenosine PC₂₀ elicited lower sensitivity and agreement. No correlation between methacholine PC₂₀ and adenosine PC₁₅ was observed. Higher fraction of exhaled nitric oxide values and sputum eosinophil counts were seen in patients with positive adenosine challenge results. The use of adenosine PC₁₅ or PC₂₀ did not alter the association with inflammatory markers.
The concordance between both techniques was low. Methacholine is not a reliable predictor of hyperresponsiveness to adenosine, leading us to conclude that the two tests are complementary but not interchangeable in clinical practice. Additionally, responsiveness to the two bronchoconstrictor stimuli does not indicate presence of the same airway abnormality. Indirect stimuli provide a better reflection of bronchial inflammation.
支气管高反应性通常通过使用直接激动剂（如乙酰甲胆碱）和间接激动剂（如腺苷）的支气管激发试验来测量。比较这两种类型药物的研究很少，且它们的一致性存在冲突。
我们试图比较这两种试验在有哮喘症状人群中的结果，以确定它们与支气管炎症标志物的关系。
本研究招募了79名年龄在14至81岁之间的患者。使用潮气量法进行激发试验。计算乙酰甲胆碱的PC₂₀以及腺苷的PC₁₅和PC₂₀。还进行了诱导痰和呼出一氧化氮分数的测量。
69%的患者存在特应性。32名患者（40.5%）的乙酰甲胆碱PC₂₀和腺苷PC₁₅呈阳性，两者的敏感性均为73%。一致性百分比为45.45%，κ指数仅为0.369。腺苷PC₂₀的敏感性和一致性较低。未观察到乙酰甲胆碱PC₂₀与腺苷PC₁₅之间的相关性。腺苷激发试验结果为阳性的患者呼出一氧化氮值和痰嗜酸性粒细胞计数较高。使用腺苷PC₁₅或PC₂₀并未改变与炎症标志物的关联。
两种技术之间的一致性较低。乙酰甲胆碱不是对腺苷高反应性的可靠预测指标，这使我们得出结论，在临床实践中这两种试验是互补的，但不可相互替代。此外，对两种支气管收缩刺激的反应性并不表明存在相同的气道异常。间接刺激能更好地反映支气管炎症。
