Tuberc Respir Dis.  2006 Nov;61(5):433-439. 10.4046/trd.2006.61.5.433.

Clinical Significance of Methacholine Bronchial Challenge Test in Differentiating Asthma From COPD

• Hong YK
• Chung CR
• Paeck KH
• Kim SR
• Min KH
• Park SJ
• Lee HB
• Lee YC
• Rhee YK

• KMID: 1970248
• DOI: http://doi.org/10.4046/trd.2006.61.5.433

Abstract

BACKGROUND: Although airway hyper-responsiveness is one of the characteristics of asthma. bronchial hyper-responsiveness has also been observed to some degree in patients with chronic obstructive pulmonary disease (COPD). Moreover, several reports have demonstrated that a number of patients have both COPD and asthma. The methacholine bronchial challenge test (MCT) is a widely used method for the detecting and quantifying the airway hyper-responsiveness, and is one of the diagnostic tools in asthma. However, the significance of MCT in differentiating asthma or COPD combined with asthma from pure COPD has not been defined. The aim of this study was to determine the role of MCT in differentiating asthma from pure COPD. METHOD: This study was performed prospectively and was composed of one hundred eleven patients who had undergone MCT at Chonbuk National University Hospital. Sixty-five asthma patients and 23 COPD patients were enrolled and their MCT data were analyzed and compared with the results of a control group. RESULT: The positive rates of MCT were 65%, 30%, and 9% in the asthma, COPD, and control groups, respectively. The mean PC20 values of the asthma, COPD, and control groups were 8.1+/-1.16 mg/mL, 16.9+/-2.21 mg/mL, and 22.0+/-1.47 mg/mL, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of MCT for diagnosing asthma were 65%, 84%, 81%, and 69%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of MCT (ed note: please check this as I believe that these values correspond to the one PC20 value. Please check my changes.) at the new cut-off points of PC20 < or = 16 mg/ml, were 80%, 75%, 78%, and 78%, respectively.
CONCLUSION
MCT using the new cut-off point can be used as a more precise and useful diagnostic tool for distinguishing asthma from pure COPD.

Keyword

Bronchial challenge test; COPD; Asthma

MeSH Terms

Asthma*
Bronchial Provocation Tests*
Humans
Jeollabuk-do
Methacholine Chloride*
Prospective Studies
Pulmonary Disease, Chronic Obstructive*
Methacholine Chloride

Figure

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  Figure 1 Positive rates of MCT in subjects with asthma or COPD and in control group. MCT positive rate of the asthma, COPD, and contol group were 65%, 30%, and 9%, respectively.

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  Figure 2 PC20 values in subjects with asthma or COPD and in control group. Each solid black bar indicates mean value of each group.

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  Figure 3 Mean values of PC20 in subjects with asthma or COPD and in control group. The mean value of asthma, 8.1±1.2 mg/ml, is lower than others significantly (P<0.05).

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  Figure 4 Mean values of PC20 in subjects with asthma, DPB and Bronchiectasis.

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  Figure 5 The differences of sensitivity, specificity, negative predictive value, and positive predictive of MCT for diagnosis of asthama at different cut-off point, PC20≤16 mg/ml, from usual cut-off value, PC20≤8.0 mg/mL.

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  Figure 6 ROC curve for MCT in diagnosis of asthma. Black arrow indicates the appropriate cut-off value, which PC20 value is 15.4 mg/mL, for diagnosis of asthma.

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