Smith L, McFadden E R
Allergy Clinical Immunology Service, Walter Reed Army Medical Center, Washington, DC, USA.
Ann Allergy Asthma Immunol. 1995 Jun;74(6):454-69, quiz 469-70.
The purpose of this article is to review bronchial reactivity: how it is detected, what are the clinical and pathologic correlates and what treatment modulates it. Is it a good diagnostic test for a disease such as asthma? Is it a reasonable parameter to follow in assessing disease severity and response to treatment?
Recent studies on human subjects in the English language medical literature involving bronchial hyperreactivity. In particular all studies were sought that correlated indices of inflammation obtained either by bronchoalveolar lavage or biopsy with degree of bronchial hyperresponsiveness. Pertinent studies reviewing disease association with presence of bronchial hyperreactivity were sought. All studies of treatment with inhaled corticosteroids were reviewed and those in which the subjects could be classified as having either mild or moderately severe asthma on the basis of the clinical information given were used to provide data on correlation of bronchial reactivity and disease severity.
The relationship of bronchial reactivity and any disease state is not straightforward. It is not clear what causes hyperreactivity of the airways but there must be other factors besides inflammation as bronchial hyperreactivity can occur without microscopic evidence of inflammation. Hyperresponsiveness does not appear to be as sensitive or specific for the diagnosis of asthma as previously thought, or as closely related to the severity of asthma. Effects of treatment appear to be somewhat independent of their impact on bronchial responsiveness.
Airway hyperresponsiveness can be found in many circumstances. Its relationship to symptom production and clinical course in any disease is not clear. Further studies are needed to elucidate the relationship between airways hyperreactivity, asthma, and other lung diseases and the factors that lead to increased bronchial reactivity.
本文旨在综述支气管反应性：如何检测它，其临床和病理相关性是什么，以及何种治疗可对其进行调节。它对于诸如哮喘之类的疾病是一项好的诊断测试吗？在评估疾病严重程度和治疗反应时，它是一个合理的跟踪参数吗？
英文医学文献中关于人类受试者的近期研究，涉及支气管高反应性。特别查找了所有将通过支气管肺泡灌洗或活检获得的炎症指标与支气管高反应性程度相关联的研究。查找了有关疾病与支气管高反应性存在之间关联的相关研究。对所有吸入性糖皮质激素治疗的研究进行了综述，并且根据所提供的临床信息，将受试者可分类为患有轻度或中度重度哮喘的那些研究用于提供支气管反应性与疾病严重程度相关性的数据。
支气管反应性与任何疾病状态之间的关系并不简单。尚不清楚气道高反应性的病因，但除炎症外肯定还有其他因素，因为在没有炎症微观证据的情况下也可发生支气管高反应性。高反应性对于哮喘的诊断似乎并不像先前认为的那样敏感或特异，也与哮喘的严重程度没有密切关系。治疗效果似乎在某种程度上独立于其对支气管反应性的影响。
气道高反应性可在多种情况下发现。其与任何疾病中症状产生和临床病程的关系尚不清楚。需要进一步研究以阐明气道高反应性、哮喘和其他肺部疾病之间的关系以及导致支气管反应性增加的因素。
