Karamarkovic Lazarusic Natasa, Popovic-Grle Sanja, Tolic Ena, Stajduhar Anamarija, Bozinovic Renata, Pavlisa Gordana
Outpatient Centre for Respiratory Diseases, 10000 Zagreb, Croatia.
Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia.
J Clin Med. 2024 Dec 27;14(1):74. doi: 10.3390/jcm14010074.
: Cough variant asthma (CVA) is characterized by nonspecific symptoms and normal spirometric values, which makes diagnosis challenging. To diagnose CVA it is necessary to document airway hyperreactivity (AHR). The aim of our study was to evaluate the diagnostic value of body plethysmography in the assessment of AHR using the methacholine challenge test (MCT). : In CVA-suspected patients, a bronchodilation test (BDT), an MCT with spirometry, and body plethysmography were performed. The MCT was considered positive if there was a 20% decrease in forced expiratory volume in 1 s from the baseline value (PCFEV) or a 40% reduction in specific conductance (PCsGaw) after inhaling methacholine of concentration < 8 mg/mL. Sensitivity and specificity were generated for different cut off points of sGaw (PCsGaw, PCsGaw, PCsGaw). Anti-asthma treatment was started for those with proven AHR. The diagnosis of asthma was made after one year of follow-up based on the response to treatment. : AHR was diagnosed in 83.5% (91/109) of patients by either a BDT, PCFEV, or PCsGaw. After one year of follow-up, asthma was confirmed in 76 patients. The sensitivities of the BDT, PCFEV, and PCsGaw were 25%, 64%, and 97%, respectively. The specificities of the BDT, PCFEV and PCsGaw were 94%, 88%, and 67%, respectively. The sensitivities for a PCsGaw and PCsGaw were 88% and 63%, and the specificities were 82% and 91%, respectively. : Body plethysmography is a valuable tool in the assessment of AHR in CVA, with the best sensitivity-to-specificity ratio found at a PCsGaw.
咳嗽变异性哮喘(CVA)的特征是症状不具特异性且肺功能测定值正常,这使得诊断具有挑战性。要诊断CVA,有必要记录气道高反应性(AHR)。我们研究的目的是评估体容积描记法在使用乙酰甲胆碱激发试验(MCT)评估AHR中的诊断价值。
在疑似CVA的患者中,进行了支气管舒张试验(BDT)、带肺功能测定的MCT以及体容积描记法。如果吸入浓度<8mg/mL的乙酰甲胆碱后1秒用力呼气容积(PCFEV)较基线值下降20%或比气道传导率(PCsGaw)降低40%,则MCT被认为阳性。针对不同的比气道传导率切点(PCsGaw、PCsGaw、PCsGaw)生成了敏感性和特异性。对确诊有AHR的患者开始进行抗哮喘治疗。根据治疗反应在随访一年后做出哮喘诊断。
通过BDT、PCFEV或PCsGaw诊断出83.5%(91/109)的患者有AHR。随访一年后,76例患者被确诊为哮喘。BDT、PCFEV和PCsGaw的敏感性分别为25%、64%和97%。BDT、PCFEV和PCsGaw的特异性分别为94%、88%和67%。PCsGaw和PCsGaw的敏感性分别为88%和63%,特异性分别为82%和91%。
体容积描记法是评估CVA中AHR的一种有价值的工具,在PCsGaw时发现其敏感性与特异性之比最佳。