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. 2001 May;56(5):362–365. doi: 10.1136/thorax.56.5.362

Repeatability of bronchial hyperresponsiveness to adenosine-5'-monophosphate (AMP) by a short dosimeter protocol

G De Meer 1, D Heederik 1, B Brunekreef 1, D Postma 1
PMCID: PMC1746039  PMID: 11312404

Abstract

BACKGROUND—To study bronchial responsiveness to adenosine 5'-monophosphate (AMP) in population surveys, repeatability of a rapid dosimetric method with quadrupling doses was evaluated.
METHODS—Volunteers with symptoms of airway respiratory allergy or asthma were invited for AMP challenges on two occasions. After each dose the fall in forced expiratory volume in one second (FEV1) compared with the post-saline value was determined. The cumulative doses of AMP needed to cause a fall in FEV1 of 20% (PD20), 15% (PD15), and 10% (PD10) were calculated. Agreement was evaluated by means of kappa values. After excluding systematic differences in PD values on two occasions (t test), repeatability of a single estimation of the chosen PD values was calculated and expressed in doubling doses (DD).
RESULTS—In 28 of 76 subjects a PD20 was estimated on the two visits, in 29 subjects a PD15 was estimated, and in 32 a PD10 was obtained. Kappa values for a positive threshold were 0.89 for a cut off level for a 20% fall in FEV1, 0.78 for a 15% fall in FEV1, and 0.76 for a fall in FEV1 of 10%. The PD values did not differ between the two visits and 95% repeatability of a single estimation was ±1.7 DD for PD20, ±2.2 DD for PD15, and ±2.4 DD for PD10. The quadrupling dose method reduced time by 40% in non-hyperresponsive subjects and no adverse effects were observed.
CONCLUSION—The short dosimeter protocol with quadrupling doses for AMP challenges is a rapid, reproducible tool for estimating bronchial responsiveness in population surveys.



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Selected References

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  1. Avital A., Springer C., Bar-Yishay E., Godfrey S. Adenosine, methacholine, and exercise challenges in children with asthma or paediatric chronic obstructive pulmonary disease. Thorax. 1995 May;50(5):511–516. doi: 10.1136/thx.50.5.511. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  3. Chinn S., Britton J. R., Burney P. G., Tattersfield A. E., Papacosta A. O. Estimation and repeatability of the response to inhaled histamine in a community survey. Thorax. 1987 Jan;42(1):45–52. doi: 10.1136/thx.42.1.45. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Crimi N., Palermo F., Oliveri R., Polosa R., Settinieri I., Mistretta A. Protective effects of inhaled ipratropium bromide on bronchoconstriction induced by adenosine and methacholine in asthma. Eur Respir J. 1992 May;5(5):560–565. [PubMed] [Google Scholar]
  5. Cushley M. J., Holgate S. T. Adenosine-induced bronchoconstriction in asthma: role of mast cell-mediator release. J Allergy Clin Immunol. 1985 Feb;75(2):272–278. doi: 10.1016/0091-6749(85)90057-0. [DOI] [PubMed] [Google Scholar]
  6. Daxun Z., Rafferty P., Richards R., Summerell S., Holgate S. T. Airway refractoriness to adenosine 5'-monophosphate after repeated inhalation. J Allergy Clin Immunol. 1989 Jan;83(1):152–158. doi: 10.1016/0091-6749(89)90490-9. [DOI] [PubMed] [Google Scholar]
  7. Egbagbe E., Pavord I. D., Wilding P., Thompson-Coon J., Tattersfield A. E. Adenosine monophosphate and histamine induced bronchoconstriction: repeatability and protection by terbutaline. Thorax. 1997 Mar;52(3):239–243. doi: 10.1136/thx.52.3.239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Knox A. J., Wisniewski A., Cooper S., Tattersfield A. E. A comparison of the Yan and a dosimeter method for methacholine challenge in experienced and inexperienced subjects. Eur Respir J. 1991 Apr;4(4):497–502. [PubMed] [Google Scholar]
  9. Kremer A. M., Pal T. M., Oldenziel M., Kerkhof M., de Monchy J. G., Rijcken B. Use and safety of a shortened histamine challenge test in an occupational study. Eur Respir J. 1995 May;8(5):737–741. [PubMed] [Google Scholar]
  10. Oosterhoff Y., de Jong J. W., Jansen M. A., Koëter G. H., Postma D. S. Airway responsiveness to adenosine 5'-monophosphate in chronic obstructive pulmonary disease is determined by smoking. Am Rev Respir Dis. 1993 Mar;147(3):553–558. doi: 10.1164/ajrccm/147.3.553. [DOI] [PubMed] [Google Scholar]
  11. Peat J. K., Salome C. M., Bauman A., Toelle B. G., Wachinger S. L., Woolcock A. J. Repeatability of histamine bronchial challenge and comparability with methacholine bronchial challenge in a population of Australian schoolchildren. Am Rev Respir Dis. 1991 Aug;144(2):338–343. doi: 10.1164/ajrccm/144.2.338. [DOI] [PubMed] [Google Scholar]
  12. Peat J. K., Unger W. R., Combe D. Measuring changes in logarithmic data, with special reference to bronchial responsiveness. J Clin Epidemiol. 1994 Oct;47(10):1099–1108. doi: 10.1016/0895-4356(94)90096-5. [DOI] [PubMed] [Google Scholar]
  13. Polosa R., Holgate S. T. Adenosine bronchoprovocation: a promising marker of allergic inflammation in asthma? Thorax. 1997 Oct;52(10):919–923. doi: 10.1136/thx.52.10.919. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Polosa R., Phillips G. D., Rajakulasingam K., Holgate S. T. The effect of inhaled ipratropium bromide alone and in combination with oral terfenadine on bronchoconstriction provoked by adenosine 5'-monophosphate and histamine in asthma. J Allergy Clin Immunol. 1991 May;87(5):939–947. doi: 10.1016/0091-6749(91)90415-k. [DOI] [PubMed] [Google Scholar]
  15. Sterk P. J., Fabbri L. M., Quanjer P. H., Cockcroft D. W., O'Byrne P. M., Anderson S. D., Juniper E. F., Malo J. L. Airway responsiveness. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993 Mar;16:53–83. [PubMed] [Google Scholar]
  16. Taylor D. A., Jensen M. W., Kanabar V., Engelstätter R., Steinijans V. W., Barnes P. J., O'Connor B. J. A dose-dependent effect of the novel inhaled corticosteroid ciclesonide on airway responsiveness to adenosine-5'-monophosphate in asthmatic patients. Am J Respir Crit Care Med. 1999 Jul;160(1):237–243. doi: 10.1164/ajrccm.160.1.9809046. [DOI] [PubMed] [Google Scholar]
  17. Weersink E. J., Douma R. R., Postma D. S., Koëter G. H. Fluticasone propionate, salmeterol xinafoate, and their combination in the treatment of nocturnal asthma. Am J Respir Crit Care Med. 1997 Apr;155(4):1241–1246. doi: 10.1164/ajrccm.155.4.9105061. [DOI] [PubMed] [Google Scholar]
  18. van Aalderen W. M., Gerritsen J., Koëter G. H., van der Weele L. T., Postma D. S., Knol K. The reproducibility and agreement of three indices of airway responsiveness to histamine in asthmatic children. Pediatr Pulmonol. 1989;6(2):113–117. doi: 10.1002/ppul.1950060211. [DOI] [PubMed] [Google Scholar]
  19. van Velzen E., van den Bos J. W., Benckhuijsen J. A., van Essel T., de Bruijn R., Aalbers R. Effect of allergen avoidance at high altitude on direct and indirect bronchial hyperresponsiveness and markers of inflammation in children with allergic asthma. Thorax. 1996 Jun;51(6):582–584. doi: 10.1136/thx.51.6.582. [DOI] [PMC free article] [PubMed] [Google Scholar]

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