Hiperrespuesta bronquial inespecífica. Análisis de la relación entre sensibilidad, reactividad y respuesta máxima

Prieto, L.; Manuel Bertó, J.; López San Martín, M.; Peris, A.

doi:10.1016/S0300-2896(15)31257-6

Article information

Para estudiar la relación entre sensibilidad (PC20FEV1), reactividad (pendiente de la curva concentración-respuesta) y respuesta máxima, hemos seleccionado 22 pacientes atópicos con PC20-metacolina ≤ 200 mg/ml y con curvas concentración-respuesta adecuadas para el análisis de la pendiente en su porción lineal. Se identificó respuesta máxima (platean) en tres de 11 pacientes asmáticos y en siete de 11 individuos con rinitis alérgica. Se encontró correlación entre el log PC20 y pendiente (r=–0,54, p<0,01) entre el log PC20 y nivel de platean (r=–0,79, p<0,01) y entre la pendiente y el nivel del platean (r=0,73, p<0,05). Además, los individuos con platean mostraron grados menores de sensibilidad bronquial que los individuos sin platean (media geométrica de la PC20 de 6,76 vs 0,76 mg/ml, p<0,001). La reactividad bronquial (pendiente) en los pacientes con platean (med + SEM: 17,6±2,6%/log mg/ml) fue menor (p<0,05) que la de los sujetos sin platean (30,1±4,3%/log mg/ml). Existe una relación entre sensibilidad, reactividad y respuesta máxima y aunque el platean se detecta con mayor frecuencia en los individuos menos sensibles, no es un hallazgo exclusivo de los sujetos no asmáticos.

To study the relation between sensitivity (PC20FEV1), reactivity (slope of the concentration-response curve) and maximum response, 22 atopic patients with PC20 methacholin ≤ 200 mg/ml and with concentration-response curves adequate for the analysis of the slope of its lineal portion were selected. Maximum response (platean) was identified in 7 of 11 individuals with allergic rhinitis. Correlatión was found between the PC20 log and slope (r=–0.54, p<0.01) between the PC20 log and plateau level (r=–0.79, p<0.01) and between the slope and the plateau level (r=0.73, p<0.05). In addition, the individuáis with plateau demonstrated lower degrees of bronchial sensitivity than those without plateau (geometric mean of the PC20 of 6.76 vs 0.76 mg/ml, p<0.001). Bronchial reactivity (slope) in patients with plateau (med + SEM: 17.6±2.6%/log mg/ml) was lower (p<0.05) than that of the subjects without plateau (30.1±4.3%/log mg/ml). There is a relation between sensitivity, reactivity and maximum response and, although the plateau is detected with greater frequency in less sensitive individuais, it is not an exclusive finding of non asthmatic subjects.

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Bibliografía

[1.]

N.M. Eiser, K.F. Kerrebijn, P.H. Quanjer.

Guidelines for standardization of bronchial challenges with (nonspecific) bronchoconstricting agents.

Bull Eur Physiopath Resp, 19 (1983), pp. 495-514

[2.]

R.R. Rosenthal.

The emerging role of bronchoprovocation.

J Allergy Clin Immunol, 64 (1979), pp. 584-588

[3.]

J. Orehek, P. Gayrard, A.P. Smith, C. Grimaud, J. Charpin.

Airway response to carbachol in normal and asthmatic subjects: distinction between bronchial sensitivity and reactivity.

Am Rev Respir Dis, 115 (1977), pp. 937-943

http://dx.doi.org/10.1164/arrd.1977.115.6.937 | Medline

[4.]

R.H. Moreno, J.C. Hogg, P.D. Paré.

Mechanics of airway narrowing.

Am Rev Respir Dis, 133 (1986), pp. 1.171-1.180

http://dx.doi.org/10.1164/arrd.1986.133.6.966 | Medline

[5.]

R.G. Townley, U.Y. Ryo, B.M. Kolotkin, B. Kang.

Bronchial sensi tivity to methacholine in current and former asthmatic and allergic rhinitis patients and control subjects.

J Allergy Clin Immunol, 56 (1975), pp. 429-442

Medline

[6.]

A.J. Woolcock, C.M. Salome, K. Yan.

The shape of the doseresponse curve to histamine in asthmatic and normal subjects.

Am Rev Respir Dis, 130 (1984), pp. 71-75

http://dx.doi.org/10.1164/arrd.1984.130.1.71 | Medline

[7.]

A.R. Glanville, J. Theodore, J.C. Baldwin, E.D. Robin.

Bronchial responsiveness after human heart-lung transplantation.

Chest, 97 (1990), pp. 1360-1366

Medline

[8.]

J.I. Du Toit, A.J. Woolcock, C.M. Salome, R. Sundrum, J.L. Black.

Characteristics of bronchial hyperresponsiveness in smokers with chronic air-flow limilation.

Am Rev Respir Dis, 134 (1986), pp. 498-501

http://dx.doi.org/10.1164/arrd.1986.134.3.498 | Medline

[9.]

L. Prieto, J. Marín.

Measurement of response to methacholine inhalation challenge in asthma and allergic rhinits. PC20 or PC35FEV1?.

Allergol Immunopathol, 18 (1990), pp. 285-289

[10.]

E.H. Bel, H. Van der Veen, J.H. Dijkman, P.J. Sterk.

The effect of inhaled budesonide on the maximal degree of airway narrowing to leukotriene D4 and methacholine in normal subjects in vivo.

Am Rev Respir Dis, 139 (1989), pp. 427-431

http://dx.doi.org/10.1164/ajrccm/139.2.427 | Medline

[11.]

E.H. Bel, M.C. Timmers, A.H. Zwinderman, J.H. Dijkman, P.J. Sterk.

The effect of inhaled corticosteroids on the maximal degree of airway narrowing to methacholine in asthmatic subjects.

Am Rev Respir Dis, 143 (1991), pp. 109-113

http://dx.doi.org/10.1164/ajrccm/143.1.109 | Medline

[12.]

E.H. Bel, A.H. Zwinderman, M.C. Timmers, J.H. Dijkman, P.J. Sterk.

The protective effect of a beta2 agonist against excessive airway narrowing in response to bronchoconstrictor stimuli in asthma and chronic obstructive lung disease.

Thorax, 46 (1991), pp. 9-14

Medline

[13.]

D.W. Cockroft, B.A. Berschied.

Slope of the dose-response cur ve: usefulness in assessing bronchial responses to inhaled histamine.

Thorax, 38 (1983), pp. 55-61

Medline

[14.]

M. Perpiñá Tordera, C. Pellicer Ciscar, V. Marco Martínez.

Sensibilidad y reactividad bronquial en los sujetos asmáticos: su interrelación y significado.

Arch Bronconeumol, 22 (1986), pp. 223-226

[15.]

K.F. Chung, B. Morgan, S.J. Keyes, P.D. Snashall.

Histamine dose-response relationships in normal and asthmatic subjects. The importance of starting airway caliber.

Am Rev Respir Dis, 126 (1982), pp. 849-854

http://dx.doi.org/10.1164/arrd.1982.126.5.849 | Medline

[16.]

J.L. Malo, A. Cartier, L. Pineau, G. Gagnon, R.R. Martín.

Slope of the dose-response curve to inhaled histamine and methacholine and PC20 in subjects with symptoms of airway hyperexcitability and in normal subjects.

Am Rev Respir Dis, 132 (1985), pp. 644-647

http://dx.doi.org/10.1164/arrd.1985.132.3.644 | Medline

[17.]

P.J. Sterk, E.E. Daniel, N. Zamel, F.E. Hargreave.

Limited bronchoconstriction to methacholine using partial flow-volume curves in nonasthmatic subjetcs.

Am Rev Respir Dis, 132 (1985), pp. 272-277

http://dx.doi.org/10.1164/arrd.1985.132.2.272 | Medline

[18.]

P.J. Sterk, M.C. Timmers, J.H. Dijkman.

Maximal airway narrowing in humans in vivo. Histamine compared with methacholine.

Am Rev Respir Dis, 134 (1986), pp. 714-718

http://dx.doi.org/10.1164/arrd.1986.134.4.714 | Medline

[19.]

American Thoracic Society.

Definitions and classifícations of chronic bronchitis, asthma and pulmonary emphysema.

Am Rev Respir Dis, 85 (1962), pp. 762-768

[20.]

American Thoracic Society.

Standardization of spirometry1987 update.

Am Rev Respir Dis, 136 (1987), pp. 1.285-1.298

http://dx.doi.org/10.1164/ajrccm/136.6.1466 | Medline

[21.]

R.O. Crapo, A.H. Morris, R.M. Gardner.

Reference spirometric values using techniques and equipment that meet ATS recommendations.

Am Rev Respir Dis, 123 (1981), pp. 659-664

http://dx.doi.org/10.1164/arrd.1981.123.6.659 | Medline

[22.]

H. Quanjer Ph.

Ed. Standardized lung function testing.

Bull Eur Physiopath Resp, 19 (1983), pp. 1-95

[23.]

L. Prieto, J. Marín.

Metodología del test de provocación bron quial con metacolina. I. Repetibilidad, definición de los puntos de corte y métodos para calcular los resultados.

Rev Esp Alergol InmunolClin, 6 (1991), pp. 103-111

[24.]

D.W. Cockcroft, D.N. Killiam, J.J.A. Mellon, F.E. Hargreave.

Bronchial reactivity to inhaled histamine: a method and clinical survey.

Clin Allergy, 7 (1977), pp. 235-243

Medline

[25.]

Prieto L, Marín J. Methacholine inhalation challenge. Practical consequences of using duplicate spirograms after each concentration. Ann Allergy (En prensa).

[26.]

D.W. Cockcroft, K.Y. Murdock, J.T. Mink.

Determination of histamine PC20. Comparison of linear and logarithmic interpolation.

Chest, 84 (1983), pp. 505-506

Medline

[27.]

N.M. Eiser.

Bronchial provocation tests.

Bronchial hyperresponsiveness., pp. 173-254

[28.]

J.L. Prieto Andrés.

Aspectos metodológicos y utilidad clínica del test de provocación bronquial con metacolina.