Allergy Asthma Respir Dis.  2013 Dec;1(4):309-313. 10.4168/aard.2013.1.4.309.

Comparison of bronchial responsiveness assessing dose-response slope between cough-variant asthma and classic asthma in young children

• Yoon JW
• Hur HY
• Jee HM
• Baek JH
• Kim HY
• Shin YH
• Han MY

• KMID: 2262587
• DOI: http://doi.org/10.4168/aard.2013.1.4.309

Abstract

PURPOSE
Little data is currently available on the use of the impulse oscillometry system (IOS) parameter in analyzing the lung function of young children with cough-variant asthma (CVA) and classic asthma. The aims of this study were to evaluate the bronchial responsiveness between patients with CVA and those with classic asthma using dose-response slope and various cutoff values.
METHODS
A methacholine challenge test and a pulmonary function test were performed in 43 children with classic asthma and 26 children with CVA using IOS, and the respiratory resistance (Rrs) and reactance (Xrs) were obtained. The bronchial responsiveness were assessed by provocative concentration causing an 80% fall from baseline in reactance at 5 Hz (PC80_Xrs5) and a 40% increase in resistance at 5 Hz (PC40_Rrs5) and calculating from the degree of dose-response slope (DRS) for airway resistance and reactance.
RESULTS
There was no significant difference in base lung function between the two groups. However, the mean DRS_Xrs5 and the number who showed more than an 80% fall in reactance were significantly higher in classic asthma group than those in CVA group (P=0.040 and P=0.040, respectively).
CONCLUSION
The use of DRS in oscillatory reactance at 5 Hz is useful for the differential diagnosis of classic asthma and CVA based on bronchial hyperresponsiveness.

Keyword

Oscillometry; Cough; Asthma; Dose response; Bronchial hyperreactivity

MeSH Terms

Airway Resistance
Asthma*
Bronchial Hyperreactivity
Child*
Cough
Diagnosis, Differential
Humans
Lung
Methacholine Chloride
Oscillometry
Respiratory Function Tests
Methacholine Chloride

Figure

• 

  Fig. 1 Comparison of dose-response slope of reactance at 5 Hz (DRS_Xrs5) between the cough-variant asthma (CVA) group and the classic asthma group. The mean value of DRS_Xrs5 in the classic asthma group was significantly higher than that in the CVA group (P=0.04).

Reference

1. Irwin RS, French CT, Smyrnios NA, Curley FJ. Interpretation of positive results of a methacholine inhalation challenge and 1 week of inhaled bronchodilator use in diagnosing and treating cough-variant asthma. Arch Intern Med. 1997; 157:1981–1987.

2. Konig P. Hidden asthma in childhood. Am J Dis Child. 1981; 135:1053–1055.

3. Fujimura M, Ogawa H, Nishizawa Y, Nishi K. Comparison of atopic cough with cough variant asthma: is atopic cough a precursor of asthma? Thorax. 2003; 58:14–18.

4. Todokoro M, Mochizuki H, Tokuyama K, Morikawa A. Childhood cough variant asthma and its relationship to classic asthma. Ann Allergy Asthma Immunol. 2003; 90:652–659.

5. De Diego A, Martinez E, Perpina M, Nieto L, Compte L, Macian V, et al. Airway inflammation and cough sensitivity in cough-variant asthma. Allergy. 2005; 60:1407–1411.

6. Niimi A, Matsumoto H, Minakuchi M, Kitaichi M, Amitani R. Airway remodelling in cough-variant asthma. Lancet. 2000; 356:564–565.

7. Beydon N, Davis SD, Lombardi E, Allen JL, Arets HG, Aurora P, et al. An official American Thoracic Society/European Respiratory Society statement: pulmonary function testing in preschool children. Am J Respir Crit Care Med. 2007; 175:1304–1345.

8. Marotta A, Klinnert MD, Price MR, Larsen GL, Liu AH. Impulse oscillometry provides an effective measure of lung dysfunction in 4-year-old children at risk for persistent asthma. J Allergy Clin Immunol. 2003; 112:317–322.

9. Nielsen KG, Bisgaard H. Discriminative capacity of bronchodilator response measured with three different lung function techniques in asthmatic and healthy children aged 2 to 5 years. Am J Respir Crit Care Med. 2001; 164:554–559.

10. Mochizuki H, Arakawa H, Tokuyama K, Morikawa A. Bronchial sensitivity and bronchial reactivity in children with cough variant asthma. Chest. 2005; 128:2427–2434.

11. Castro-Rodriguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med. 2000; 162(4 Pt 1):1403–1406.

12. Niimi A, Amitani R, Suzuki K, Tanaka E, Murayama T, Kuze F. Eosinophilic inflammation in cough variant asthma. Eur Respir J. 1998; 11:1064–1069.

13. Oostveen E, MacLeod D, Lorino H, Farre R, Hantos Z, Desager K, et al. The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J. 2003; 22:1026–1041.

14. Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, et al. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000; 161:309–329.

15. Broeders ME, Molema J, Hop WC, Folgering HT. Bronchial challenge, assessed with forced expiratory manoeuvres and airway impedance. Respir Med. 2005; 99:1046–1052.

16. Jee HM, Kwak JH, Jung DW, Han MY. Useful parameters of bronchial hyperresponsiveness measured with an impulse oscillation technique in preschool children. J Asthma. 2010; 47:227–232.

17. Statement of the American Thoracic Society. Standardization of spirometry: 1987 update. Am Rev Respir Dis. 1987; 136:1285–1298.

18. Izbicki G, Bar-Yishay E. Methacholine inhalation challenge: a shorter, cheaper and safe approach. Eur Respir J. 2001; 17:46–51.

19. Ownby DR, Peterson EL, Johnson CC. Factors related to methacholine airway responsiveness in children. Am J Respir Crit Care Med. 2000; 161:1578–1583.

20. Jayet PY, Schindler C, Kunzli N, Zellweger JP, Brandli O, Perruchoud AP, et al. Reference values for methacholine reactivity (SAPALDIA study). Respir Res. 2005; 6:131.

21. Bohadana AB, Peslin R, Megherbi SE, Teculescu D, Sauleau EA, Wild P, et al. Dose-response slope of forced oscillation and forced expiratory parameters in bronchial challenge testing. Eur Respir J. 1999; 13:295–300.

22. Garcia-Rio F, Mediano O, Ramirez M, Vinas A, Alonso A, Alvarez-Sala R, et al. Usefulness of bronchial reactivity analysis in the diagnosis of bronchial asthma in patients with bronchial hyperresponsiveness. Respir Med. 2004; 98:199–204.

23. Bouaziz N, Beyaert C, Gauthier R, Monin P, Peslin R, Marchal F. Respiratory system reactance as an indicator of the intrathoracic airway response to methacholine in children. Pediatr Pulmonol. 1996; 22:7–13.

24. Koh YY, Park Y, Kim CK. The importance of maximal airway response to methacholine in the prediction of wheezing development in patients with cough-variant asthma. Allergy. 2002; 57:1165–1170.

25. Koh YY, Jeong JH, Park Y, Kim CK. Development of wheezing in patients with cough variant asthma during an increase in airway responsiveness. Eur Respir J. 1999; 14:302–308.

26. Kang H, Koh YY, Yoo Y, Yu J, Kim DK, Kim CK. Maximal airway response to methacholine in cough-variant asthma: comparison with classic asthma and its relationship to peak expiratory flow variability. Chest. 2005; 128:3881–3887.

27. Kelly VJ, Brown NJ, Sands SA, Borg BM, King GG, Thompson BR. Effect of airway smooth muscle tone on airway distensibility measured by the forced oscillation technique in adults with asthma. J Appl Physiol (1985). 2012; 112:1494–1503.