Allergy, Asthma & Respiratory Disease

  • 제12권3호
  • /
  • Pages.140-146
  • /
  • 2024
  • /
  • 2288-0402(pISSN)
  • /
  • 2288-0410(eISSN)
대한천식알레르기학회 (The Korean Academy of Asthma, Allergy and Clinical Immunology)
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메타콜린 기관지유발검사의 세 프로토콜 비교

Comparison of 3 protocols in the methacholine bronchial provocation test

  • 강성윤 (가천대학교 의과대학 가천대학교 길병원 알레르기내과) ;
  • 손지우 (가천대학교 의과대학 가천대학교 길병원 내과) ;
  • 이상민 (단국대학교 의과대학 호흡기알레르기내과학교실) ;
  • 김세훈 (분당서울대학교병원 알레르기내과) ;
  • 김태범 (울산대학교 의과대학 서울아산병원 알레르기내과) ;
  • 이상표 (가천대학교 의과대학 가천대학교 길병원 알레르기내과)
  • Sung-Yoon Kang (Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine) ;
  • Jiewoo Son (Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine) ;
  • Sang Min Lee (Division of Respiratory Diseases and Allergy, Department of Internal Medicine, Dankook University College of Medicine) ;
  • Sae-Hoon Kim (Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital) ;
  • Tae-Bum Kim (Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sang Pyo Lee (Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine)
  • 투고 : 2024.01.03
  • 심사 : 2024.02.27
  • 발행 : 2024.07.30
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초록

Purpose: In Korea, KoKo dosimetry and Aerosol Provocation System (APS) are used in the methacholine provocation test (MBPT). In this study, three protocols of the MBPT were compared. Methods: In patients showing a positive MBPT using short 2-concentration methods for APS with cumulative provocative doses of methacholine which results in a 20% fall in forced expiratory volume in 1 second (FEV1) (PD20) ≤ 962.81, the MBPT was repeated, using 14-breaths methods for APS. In them, PD20 of those 2 protocols were compared to each other. Provocative concentration of methacholine which results in a 20% fall in FEV1 (PC20) in 14-breaths methods was also compared with that of 5-breaths methods in other patients showing a positive MBPT with KoKo dosimettry during the study period. Results: The positive rate in short 2-concentration methods was 18.1% (43 of 238), while that in 5-breaths methods was 14.0% (6 of 43). They were not different from each other (P=0.342). In 7 patients who underwent the MBPT twice, using short 2-concentration and subsequent 14-breaths methods. The median of PD20 with a positive MBPT using short 2-concentration methods was 573.8 ㎍ with interquartile range (IQR) of 147.8-682.3 ㎍, whereas that in repeated MBPT using 14-breaths methods was 526.4 ㎍ (IQR, 95.0-907.1 ㎍). They did not differ from each other (P=0.735). The median of PC20 in MBPT using 14-breaths methods was 4.76 mg/mL (IQR, 0.066-10.3 mg/mL) tended to be higher than that in other 6 patients who showed a positive MBPT using 5-breaths methods, 1.95 mg/mL (IQR, 0.42-4.85 mg/mL), but it was not significant (P=0.534). Conclusion: Bronchial hyperresponsiveness was not different in 3 protocols of MBPT.

키워드

과제정보

This research was supported by a grant of Gachon University Gil Medical Center (GCU-202308910001) and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI19C0481, HC20C0076).

참고문헌

  1. Sohn KH, Kim H, Kim BK, Kim JH, Lee S, Lee JH, et al. Report on the methacholine bronchial provocation test protocol: an updated statement of Korean Academy of Asthma, Allergy and Clinical Immunology. Allergy Asthma Respir Dis 2023;11:56-62.
  2. McCracken JL, Veeranki SP, Ameredes BT, Calhoun WJ. Diagnosis and management of asthma in adults: a review. JAMA 2017;318:279-90.
  3. 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;161:309-29.
  4. Prieto L, Lopez V, Llusar R, Rojas R, Marin J. Differences in the response to methacholine between the tidal breathing and dosimeter methods: influence of the dose of bronchoconstrictor agent delivered to the mouth. Chest 2008;134:699-703.
  5. Cockcroft DW, Davis BE, Todd DC, Smycniuk AJ. Methacholine challenge: comparison of two methods. Chest 2005;127:839-44.
  6. Cockcroft DW, Davis BE. The bronchoprotective effect of inhaling methacholine by using total lung capacity inspirations has a marked influence on the interpretation of the test result. J Allergy Clin Immunol 2006;117:1244-8.
  7. Coates AL, Wanger J, Cockcroft DW, Culver BH; Bronchoprovocation Testing Task Force: Kai-Hakon Carlsen, et al. ERS technical standard on bronchial challenge testing: general considerations and performance of methacholine challenge tests. Eur Respir J 2017;49:1601526.
  8. Coates AL, Dell SD, Cockcroft DW, Gauvreau GM. The PD(20) but not the PC(20) in a methacholine challenge test is device independent. Ann Allergy Asthma Immunol 2017;118:508-9.
  9. Dell SD, Bola SS, Foty RG, Marshall LC, Nelligan KA, Coates AL. Provocative dose of methacholine causing a 20% drop in FEV1 should be used to interpret methacholine challenge tests with modern nebulizers. Ann Am Thorac Soc 2015;12:357-63.
  10. Coates AL, Leung K, Dell SD. Developing alternative delivery systems for methacholine challenge tests. J Aerosol Med Pulm Drug Deliv 2014;27:66-70.
  11. Merget R, Jorres RA, Heinze E, Haufs MG, Taeger D, Bruning T. Development of a 1-concentration-4-step dosimeter protocol for methacholine testing. Respir Med 2009;103:607-13.
  12. Schulze J, Rosewich M, Riemer C, Dressler M, Rose MA, Zielen S. Methacholine challenge--comparison of an ATS protocol to a new rapid single concentration technique. Respir Med 2009;103:1898-903.
  13. Wegmann M. Th2 cells as targets for therapeutic intervention in allergic bronchial asthma. Expert Rev Mol Diagn 2009;9:85-100.
  14. Hvidtfeldt M, Sverrild A, Pulga A, Frossing L, Silberbrandt A, Hostrup M, et al. Airway hyperresponsiveness reflects corticosteroid-sensitive mast cell involvement across asthma phenotypes. J Allergy Clin Immunol 2023;152:107-16.e4.
  15. Andreasson LM, Dyhre-Petersen N, Hvidtfeldt M, Jorgensen GO, Von Bulow A, Klein DK, et al. Airway hyperresponsiveness correlates with airway TSLP in asthma independent of eosinophilic inflammation. J Allergy Clin Immunol 2024;153:988-97.e11.