Allergy Asthma Immunol Res.  2018 Mar;10(2):131-136. 10.4168/aair.2018.10.2.131.

Dyspnea Perception During Induced Bronchoconstriction Is Complicated by the Inhaled Methacholine in Children With Clinical Asthma

• Choi YJ
• Suh DI
• Sohn MH
• Koh YY

• KMID: 2402972
• DOI: http://doi.org/10.4168/aair.2018.10.2.131

Abstract

PURPOSE
Dyspnea is not widely utilized as an indicator of asthma provocation despite its universal presentation. We hypothesized that dyspnea severity was proportionate with the lung function decline, methacholine dose-step, and the degree of bronchial hyperresponsiveness (BHR).
METHODS
We retrospectively analyzed 73 children's bronchial provocation test data with an assessment of dyspnea at every dose-step. Dyspnea severity was scored using a modified Borg (mBorg) scale. A linear mixed effect analysis was performed to evaluate the relationship between the mBorg scale, the percentage fall in the forced expiratory volume in 1 second (FEV1) (ΔFEV1%), the methacholine dose-step, and the degree of BHR (BHR grade).
RESULTS
Subjects were divided into 5 BHR groups based on their last methacholine dose-steps. The mBorg scores did not differ significantly among BHR groups (P=0.596, Kruskal-Wallis test). The linear mixed effect analysis showed that ΔFEV1% was affected by the methacholine dose-step (P < 0.001) and BHR grade (P < 0.001). The mBorg score was affected by the dose-step (P < 0.001) and BHR grade (P=0.019). We developed a model to predict the mBorg score and found that it was affected by the methacholine dose-step and ΔFEV1%, elevating it by a score of 0.039 (χ² [1]=21.06, P < 0.001) and 0.327 (χ² [1]=47.45, P < 0.001), respectively. A significant interaction was observed between the methacholine dose-step and ΔFEV1% (χ² [1]=16.20, P < 0.001).
CONCLUSIONS
In asthmatic children, inhaled methacholine, as well as the degree of BHR and lung function decline, may affect dyspnea perception during the bronchial provocation test. If we wish to draw meaningful information from dyspnea perception, we have to consider various complicating factors underlying it.

Keyword

Asthma; bronchial provocation test; child; dyspnea; methacholine

MeSH Terms

Asthma*
Bronchial Provocation Tests
Bronchoconstriction*
Child*
Dyspnea*
Forced Expiratory Volume
Humans
Lung
Methacholine Chloride*
Retrospective Studies
Methacholine Chloride

Figure

• 

  Fig. 1 Graph of the changes in FEV1 according to BHR grade by increasing dose-step. The linear mixed effect analysis showed that the methacholine dose-step affected ΔFEV1%. The BHR grades also affected ΔFEV1%. FEV1, forced expiratory volume in 1 second; BHR, bronchial hyperresponsiveness; ΔFEV1%, percentage fall in the forced expiratory volume in 1 second from baseline.

• 

  Fig. 2 Distribution of the median mBorg scores in each BHR group during the methacholine provocation test. Except for one point (BHR grade IV at a methacholine concentration of 2.5 mg/mL), the median mBorg score increased with higher dose-steps in all BHR groups. mBorg, modified Borg; BHR, bronchial hyperresponsiveness.

• 

  Fig. 3 Distribution of the mean value of ΔFEV1% per each mBorg score according to dose step. A significant interaction was observed between the methacholine dose step and ΔFEV1%. mBorg, modified Borg; ΔFEV1%, percentage fall in the forced expiratory volume in 1 second from baseline; FEV1, forced expiratory volume in 1 second.

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