Borges Marcos de Carvalho, Ferraz Erica, Vianna Elcio Oliveira
Divisão Pulmonar- Department of Medicine, Universidade de São Paulo, Ribeirão Preto, Brazil.
Sao Paulo Med J. 2011;129(4):243-9. doi: 10.1590/s1516-31802011000400008.
Bronchial hyperresponsiveness, which consists of an exaggerated response of the airways to bronchoconstrictor stimuli, is one of the main characteristics of asthma, presented in nearly all asthmatic patients. Bronchial hyperresponsiveness may also be present in other diseases, such as allergic rhinitis, chronic obstructive pulmonary disease, cystic fibrosis, heart failure and respiratory infection, and with some medications, such as β-blockers. Bronchial provocation tests (also known as bronchial challenges) are used to evaluate bronchial responsiveness. These tests have become increasingly used over the last 20 years, with the development and validation of accurate, safe and reproducible tests, and with the publication of well-detailed protocols. Several stimuli can be used in a bronchial challenge, and they are classified as direct and indirect stimuli. There are many indications for a bronchial challenge. In this review, we discuss the main differences between direct and indirect stimuli, and the use of bronchial challenges in clinical practice, especially for confirming diagnoses of asthma, exercise-induced bronchoconstriction and cough-variant asthma, and for use among elite-level athletes.
支气管高反应性是指气道对支气管收缩刺激的过度反应，是哮喘的主要特征之一，几乎所有哮喘患者都有此表现。支气管高反应性也可能存在于其他疾病中，如过敏性鼻炎、慢性阻塞性肺疾病、囊性纤维化、心力衰竭和呼吸道感染，以及某些药物（如β受体阻滞剂）使用过程中。支气管激发试验（也称为支气管挑战试验）用于评估支气管反应性。在过去20年里，随着准确、安全且可重复的试验的开发与验证以及详细方案的发表，这些试验的应用越来越广泛。支气管激发试验中可使用多种刺激物，它们可分为直接刺激物和间接刺激物。支气管激发试验有多种适应证。在本综述中，我们讨论直接刺激物和间接刺激物之间的主要差异，以及支气管激发试验在临床实践中的应用，特别是用于确诊哮喘、运动诱发性支气管收缩和咳嗽变异性哮喘，以及在精英运动员中的应用。
