Sánchez-García Silvia, Rodríguez del Río Pablo, Escudero Carmelo, García-Fernández Cristina, Ibáñez Maria Dolores
Allergy Section, Niño Jesús University Children's Hospital, Madrid, Spain; Instituto de Investigación Sanitaria - IIS, Princesa University Hospital, Madrid, Spain.
Pediatr Allergy Immunol. 2015 Feb;26(1):73-9. doi: 10.1111/pai.12319.
The diagnosis of exercise-induced asthma or bronchospasm (EIB) is a complex dare in daily clinical practice. The consensus is that if bronchial hyper-responsiveness (BHR) is demonstrated in a patient with symptoms consistent with EIB, then that patient can be diagnosed with exercise-induced bronchospasm. The aim of this study was to determine which BHR test is the most efficient to diagnose EIB.
Children under 16, without previous asthma diagnosis, or with stable asthma, complaining of asthma-like symptoms triggered by exercise were included. Bronchodilator, methacholine, mannitol, and exercise tests were performed on all patients, following established protocols. The performance of single and combined tests was determined.
Of 46 patients (median age: 12 yr, ranged 8-16 y.o.) were recruited, 30 (70%) previously diagnosed of asthma. BHR was detected in 93.47% of the children. The exercise challenge test detected BHR in 11 of 46 (23.90%) patients, bronchodilator test in 10 of 46 (21.70%), mannitol in 36 of 45 (80%) and methacholine in 41 of 45 (91.11%). The total number of patients with BHR was detected using a combination of the methacholine and mannitol tests. A combination of the methacholine test performed first, followed by the mannitol test, was able to diagnose BHR in 100% of children with lower number of tests (n = 45) than if the order was reversed (n = 50).
Methacholine and mannitol tests detect BHR in most children with suspected EIB. Bronchodilator and exercise tests show a low positivity rate. A combination of the methacholine test, followed by the mannitol test, gives the highest return to identify BHR in children for the diagnosis of EIB.
运动诱发性哮喘或支气管痉挛（EIB）的诊断在日常临床实践中是一项复杂的挑战。目前的共识是，如果在有与EIB相符症状的患者中证实存在支气管高反应性（BHR），那么该患者可被诊断为运动诱发性支气管痉挛。本研究的目的是确定哪种BHR测试对诊断EIB最有效。
纳入16岁以下、既往未诊断哮喘或哮喘病情稳定、主诉运动引发哮喘样症状的儿童。按照既定方案，对所有患者进行支气管扩张剂、乙酰甲胆碱、甘露醇和运动测试。确定单项测试和联合测试的效能。
共招募46例患者（中位年龄：12岁，范围8 - 16岁），其中30例（70%）既往诊断为哮喘。93.47%的儿童检测到BHR。运动激发试验在46例患者中的11例（23.90%）检测到BHR，支气管扩张剂试验在46例中的10例（21.70%），甘露醇试验在45例中的36例（80%），乙酰甲胆碱试验在45例中的41例（91.11%）。使用乙酰甲胆碱和甘露醇试验联合检测出BHR的患者总数最多。先进行乙酰甲胆碱试验，随后进行甘露醇试验的联合检测，能够在所有儿童中诊断出BHR，且与测试顺序相反时相比（n = 50），所需测试次数更少（n = 45）。
乙酰甲胆碱和甘露醇试验在大多数疑似EIB的儿童中检测到BHR。支气管扩张剂和运动试验的阳性率较低。乙酰甲胆碱试验后进行甘露醇试验的联合检测，在诊断EIB的儿童中识别BHR的回报率最高。
