Frequency and determinants of exaggerated bronchoconstriction during shortened methacholine challenge tests in epidemiological and clinical set-ups

The European Respiratory Society guidelines on bronchial provocation testing have proposed time-saving procedures, which may lead to unwanted exaggerated responses. The frequency and determinants of exaggerated bronchoconstriction in response to methacholine inhalation testing in clinical and epidemiological settings have not been assessed. The authors evaluated: 1) the prevalence of exaggerated bronchoconstriction, 2) its relation to time-saving measures (starting methacholine concentration and skipping concentrations); and 3) associations between such reactions and risk factors, respiratory symptoms and/or lung function parameters. Clinical (n=408) and epidemiological (n=711) groups were included. Exaggerated bronchoconstriction was defined as either a fall > or =20% following saline or a > or =30% fall in forced expiratory volume in one second (FEV1) after methacholine inhalations. Cases were compared with two groups of subjects: 1) with measurable bronchial responsiveness (MBR); and 2) without MBR. In the epidemiological group, 84 subjects (12%) presented exaggerated bronchoconstriction. Skipped concentrations accounted for an exaggerated bronchoconstriction in 18 of these. In the clinical group, 41 subjects (10%) experienced exaggerated reactions. Skipped concentrations accounted for an exaggerated bronchoconstriction in five of these. The provocative concentration of methacholine causing a 20% fall in FEV1 values were marginally lower in subjects with exaggerated bronchoconstriction. Questionnaire analysis in epidemiological subjects showed some symptoms of asthma and rhinitis to be more prevalent in cases than in subjects without MBR. In conclusion, methacholine inhalation tests with time-saving measures result in a 10% risk of exaggerated bronchoconstriction as defined in this study and bronchial responsiveness is more prominent in subjects with exaggerated bronchoconstriction.

This article has been cited by other articles:

				E Suarthana, D Heederik, H Ghezzo, J-L Malo, S M Kennedy, and D Gautrin Risks for the development of outcomes related to occupational allergies: an application of the asthma-specific job exposure matrix compared with self-reports and investigator scores on job-training-related exposure Occup. Environ. Med., April 1, 2009; 66(4): 256 - 263. [Abstract] [Full Text] [PDF]

				E Suarthana, J-L Malo, D Heederik, H Ghezzo, J L'Archeveque, and D Gautrin Which tools best predict the incidence of work-related sensitisation and symptoms Occup. Environ. Med., February 1, 2009; 66(2): 111 - 117. [Abstract] [Full Text] [PDF]

				D. Gautrin, H. Ghezzo, C. Infante-Rivard, M. Magnan, J. L'Archeveque, E. Suarthana, and J.-L. Malo Long-Term Outcomes in a Prospective Cohort of Apprentices Exposed to High-Molecular-Weight Agents Am. J. Respir. Crit. Care Med., April 15, 2008; 177(8): 871 - 879. [Abstract] [Full Text] [PDF]

				K Boutet, J-L Malo, H Ghezzo, and D Gautrin Airway hyperresponsiveness and risk of chest symptoms in an occupational model Thorax, March 1, 2007; 62(3): 260 - 264. [Abstract] [Full Text] [PDF]

				J-L. Malo, A. Cartier, C. Lemiere, A. Desjardins, M. Labrecque, J. L'Archeveque, G. Perrault, J. Lesage, and Y. Cloutier Exaggerated bronchoconstriction due to inhalation challenges with occupational agents Eur. Respir. J., February 1, 2004; 23(2): 300 - 303. [Abstract] [Full Text] [PDF]

				C. Wubbel, M. J. Asmus, G. Stevens, S. E. Chesrown, and L. Hendeles Methacholine Challenge Testing*: Comparison of the Two American Thoracic Society-Recommended Methods Chest, February 1, 2004; 125(2): 453 - 458. [Abstract] [Full Text] [PDF]

				M. El-Zein, J-L. Malo, C. Infante-Rivard, and D. Gautrin Incidence of probable occupational asthma and changes in airway calibre and responsiveness in apprentice welders Eur. Respir. J., September 1, 2003; 22(3): 513 - 518. [Abstract] [Full Text] [PDF]

				D. Gautrin, A.J. Newman-Taylor, H. Nordman, and J-L. Malo Controversies in epidemiology of occupational asthma Eur. Respir. J., September 1, 2003; 22(3): 551 - 559. [Abstract] [Full Text] [PDF]

				E. Bar-Yishay, D. W. Cockcroft, D. D. Marciniuk, T. S. Hurst, D. J. Cotton, K. F. Laframboise, B. D. McNab, and R. P. Skomro Abbreviated Methacholine Challenge: How Safe Are Short Procedures? Chest, August 1, 2002; 122(2): 752 - 753. [Full Text] [PDF]

				D. W. Cockcroft, D. D. Marciniuk, T. S. Hurst, D. J. Cotton, K. F. Laframboise, B. D. McNab, and R. P. Skomro Methacholine Challenge : Test-Shortening Procedures Chest, December 1, 2001; 120(6): 1857 - 1860. [Abstract] [Full Text] [PDF]

				D. Gautrin, H. Ghezzo, C. Infante-Rivard, and J-L. Malo Natural history of sensitization, symptoms and occupational diseases in apprentices exposed to laboratory animals Eur. Respir. J., May 1, 2001; 17(5): 904 - 908. [Abstract] [Full Text] [PDF]

				D. GAUTRIN, C. INFANTE-RIVARD, H. GHEZZO, and J.-L. MALO Incidence and Host Determinants of Probable Occupational Asthma in Apprentices Exposed to Laboratory Animals Am. J. Respir. Crit. Care Med., March 15, 2001; 163(4): 899 - 904. [Abstract] [Full Text]

				D. Gautrin, H. Ghezzo, C. Infante-Rivard, and J-L. Malo Host determinants for the development of allergy in apprentices exposed to laboratory animals Eur. Respir. J., January 1, 2001; 19(1): 96 - 103. [Abstract] [Full Text] [PDF]