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. 1993 May;48(5):512–517. doi: 10.1136/thx.48.5.512

Variability of the plateau response to methacholine in subjects without respiratory symptoms.

M D Lougheed 1, G Pearce-Pinto 1, N H de Klerk 1, G Ryan 1, A W Musk 1, A James 1
PMCID: PMC464505  PMID: 8322238

Abstract

BACKGROUND--Interpretation of measurements of limited maximal airway narrowing, or plateau response, requires knowledge of its variability within subjects and between methods. METHODS--The repeatability of the plateau response to inhaled methacholine with a dosimeter (D) method (maximal dose 210 mumol) and a tidal breathing (T) method (730 mumol), and the agreement of the two methods, were measured in 16 subjects with mild or no asthma. Two tests by each method (D1,D2,T1,T2) were performed in random order over four consecutive days, with a third dosimeter (D3) test one week later. The dose producing a decrease in forced expiratory volume in one second (FEV1) of 10% (PD10) and the plateau were calculated from each dose-response curve. RESULTS--A plateau was reached in all five tests in 12 subjects and in all tests except D3 in 14 subjects. PD10 was inversely related to the plateau (r = -0.95 for D, r = -0.77 for T). The 95% ranges for differences between two determinations of the plateau in a subject were +/- 11.9% (change in FEV1), +/- 19.2%, and +/- 20.3%, estimated from D1-2 and 1-3, and T1-2 tests, respectively. From the same tests the 95% ranges for the difference of a single determination from an individual's true mean value were +/- 8.3%, +/- 13.6%, and +/- 14.3%. The limits of agreement between methods indicated that 95% of the measurements of the plateau by tidal breathing ranged from 15.2% below to 13.3% above those obtained by dosimeter. There was no significant bias between methods. Tachyphylaxis over 24 hours occurred with PD10 but not with the plateau response. CONCLUSIONS--The plateau response is a subject characteristic which is independent of the method of inhalation challenge testing. Repeatability of the plateau is low in this group of subjects with low airway responsiveness.

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Selected References

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  1. Balzano G., Delli Carri I., Gallo C., Cocco G., Melillo G. Intrasubject between-day variability of PD20 methacholine assessed by the dosimeter inhalation test. Chest. 1989 Jun;95(6):1239–1243. doi: 10.1378/chest.95.6.1239. [DOI] [PubMed] [Google Scholar]
  2. Bel E. H., van der Veen H., Dijkman J. H., Sterk P. J. The effect of inhaled budesonide on the maximal degree of airway narrowing to leukotriene D4 and methacholine in normal subjects in vivo. Am Rev Respir Dis. 1989 Feb;139(2):427–431. doi: 10.1164/ajrccm/139.2.427. [DOI] [PubMed] [Google Scholar]
  3. Bel E. H., van der Veen H., Kramps J. A., Dijkman J. H., Sterk P. J. Maximal airway narrowing to inhaled leukotriene D4 in normal subjects. Comparison and interaction with methacholine. Am Rev Respir Dis. 1987 Oct;136(4):979–984. doi: 10.1164/ajrccm/136.4.979. [DOI] [PubMed] [Google Scholar]
  4. 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]
  5. Chai H., Farr R. S., Froehlich L. A., Mathison D. A., McLean J. A., Rosenthal R. R., Sheffer A. L., Spector S. L., Townley R. G. Standardization of bronchial inhalation challenge procedures. J Allergy Clin Immunol. 1975 Oct;56(4):323–327. doi: 10.1016/0091-6749(75)90107-4. [DOI] [PubMed] [Google Scholar]
  6. Cherniack R. M., Raber M. B. Normal standards for ventilatory function using an automated wedge spirometer. Am Rev Respir Dis. 1972 Jul;106(1):38–46. doi: 10.1164/arrd.1972.106.1.38. [DOI] [PubMed] [Google Scholar]
  7. 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]
  8. Chinn S. Statistics in respiratory medicine. 1. Ranges, confidence intervals, and related quantities: what they are and when to use them. Thorax. 1991 May;46(5):391–393. doi: 10.1136/thx.46.5.391. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cockcroft D. W., Killian D. N., Mellon J. J., Hargreave F. E. Bronchial reactivity to inhaled histamine: a method and clinical survey. Clin Allergy. 1977 May;7(3):235–243. doi: 10.1111/j.1365-2222.1977.tb01448.x. [DOI] [PubMed] [Google Scholar]
  10. Ding D. J., Martin J. G., Macklem P. T. Effects of lung volume on maximal methacholine-induced bronchoconstriction in normal humans. J Appl Physiol (1985) 1987 Mar;62(3):1324–1330. doi: 10.1152/jappl.1987.62.3.1324. [DOI] [PubMed] [Google Scholar]
  11. Guillemi S., James A. L., Pare P. D. Effect of breathing pattern during inhalation challenge on the shape and position of the dose-response curve. Lung. 1989;167(2):95–106. doi: 10.1007/BF02714936. [DOI] [PubMed] [Google Scholar]
  12. Hargreave F. E., Ryan G., Thomson N. C., O'Byrne P. M., Latimer K., Juniper E. F., Dolovich J. Bronchial responsiveness to histamine or methacholine in asthma: measurement and clinical significance. J Allergy Clin Immunol. 1981 Nov;68(5):347–355. doi: 10.1016/0091-6749(81)90132-9. [DOI] [PubMed] [Google Scholar]
  13. Irwig L. M., Simpson J. M. Assessing agreement. Med J Aust. 1989 Aug 21;151(4):235–236. doi: 10.5694/j.1326-5377.1989.tb116001.x. [DOI] [PubMed] [Google Scholar]
  14. Juniper E. F., Frith P. A., Dunnett C., Cockcroft D. W., Hargreave F. E. Reproducibility and comparison of responses to inhaled histamine and methacholine. Thorax. 1978 Dec;33(6):705–710. doi: 10.1136/thx.33.6.705. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Moreno R. H., Hogg J. C., Paré P. D. Mechanics of airway narrowing. Am Rev Respir Dis. 1986 Jun;133(6):1171–1180. doi: 10.1164/arrd.1986.133.6.1171. [DOI] [PubMed] [Google Scholar]
  16. Ryan G., Dolovich M. B., Roberts R. S., Frith P. A., Juniper E. F., Hargreave F. E., Newhouse M. T. Standardization of inhalation provocation tests: two techniques of aerosol generation and inhalation compared. Am Rev Respir Dis. 1981 Feb;123(2):195–199. doi: 10.1164/arrd.1981.123.2.195. [DOI] [PubMed] [Google Scholar]
  17. Sterk P. J., Bel E. H. Bronchial hyperresponsiveness: the need for a distinction between hypersensitivity and excessive airway narrowing. Eur Respir J. 1989 Mar;2(3):267–274. [PubMed] [Google Scholar]
  18. Sterk P. J., Daniel E. E., Zamel N., Hargreave F. E. Limited bronchoconstriction to methacholine using partial flow-volume curves in nonasthmatic subjects. Am Rev Respir Dis. 1985 Aug;132(2):272–277. doi: 10.1164/arrd.1985.132.2.272. [DOI] [PubMed] [Google Scholar]
  19. Woolcock A. J., Salome C. M., Yan K. The shape of the dose-response curve to histamine in asthmatic and normal subjects. Am Rev Respir Dis. 1984 Jul;130(1):71–75. doi: 10.1164/arrd.1984.130.1.71. [DOI] [PubMed] [Google Scholar]
  20. Yan K., Salome C., Woolcock A. J. Rapid method for measurement of bronchial responsiveness. Thorax. 1983 Oct;38(10):760–765. doi: 10.1136/thx.38.10.760. [DOI] [PMC free article] [PubMed] [Google Scholar]

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