The Particularities of Airway Hyperresponsiveness to Histamine in Bronchial Asthma School-Age Children in Different Inflammatory Phenotypes
On the base of the Chernivtsy Regional Children Clinical Hospital the diagnostic value of the indices of airway hyperresponsiveness to histamine for a verification of asthma inflammatory phenotypes have been studied in 83 school age children with persistent bronchial asthma. The first (I) clinical group consisted of 47 (56,6 %) children with eosinophilic asthma phenotype. The second (II) clinical group included the remaining 36 (43,4 %) patients with non-eosinophilic/neutrophilic bronchial asthma. The non-specific bronchial hyperresposiveness to direct stimuli using spirometric provocative test with inhalation of the serial dilutions of histamine has been performed by the method of E.F. Juniper (1994). There have been calculated such indices: provocative concentration of histamine (PC20H), provocative dose of histamine (PD20H) and dose-response slope. To evaluate the diagnostic value of the tests their sensitivity, specificity, the positive and negative predictive values have been measured. Bronchial provocation test with inhalation of serial dilutions of histamine should be used for bronchial asthma verification in school-age children. Namely PC20H < 8.0 mg/ml appears highly sensitive screening test (95 %) in the diagnosis of different inflammatory asthma phenotypes. None of the indices of non-specific bronchial hyperresponsiveness to histamine can be used independently as a screening method for verification of eosinophilic asthma phenotype because of the high incidence of false negative results. The index of bronchial hyperresponsiveness to histamine (dose-relative slope ≥ 3.0 arbitrary units) is the most informative to confirm eosinophilic asthma phenotype due to the high specificity of the test (94 %) and a small number (17 %) of a false diagnosis of eosinophil-associated airway inflammation in its absence.
Toyran M., Bakirtas A., Dogruman-Al F. et al. Airway inflammation and bronchial hyperreactivity in steroid naive children with intermittent and mild persistent asthma Pediatric Pulmonology. 2014; 49 (2):140–147. DOI: 10.1002/ppul.22810
Bougault V., Turmel J., Boulet L.-Р. Bronchial challenges and respiratory symptoms in elite swimmers and winter sport athletes. Airway hyperresponsiveness in asthma: its measurement and clinical significance Chest.2010; 138 (2) (Suppl): 31S-37S. DOI 10.1378/chest.09-1689
Broide D.H., ChB M.B. Immunologic and inflammatory mechanisms that drive asthma progression to remodeling J. Allergy Clin. Immunol.2008;121(3):560-572. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386668/
Cho J.Y. Recent advances in mechanisms and treatments of airway remodeling in asthma: a message from the bench side to the clinic Korean J. Intern. Med. 2011; 26 (4): 367-383. doi: 10.3904/kjim.2011.26.4.367
Zedan M., Attia G., Zedan M.M., Osman A. et al. Clinical asthma phenotypes and therapeutic responses ISRN Pediatrics. 2013. Article ID 824781: 1-7. http://dx.doi.org/10.1155/2013/824781
Commins S., Stenke J.W., Borish L. The extended IL-10 superfamily: IL-10, IL-19, IL-20, IL-22, IL- 24, IL- 26, IL-28 and IL-29 J. Allergy Clin. Immunol. 2008; 121: 1108- 1111. doi: 10.1016/j.jaci.2008.02.026.
Cowan D.C., Cowan J.O., Palmay R. et al. Effects of steroid therapy on inflammatory cell subtypes in asthma Thorax. 2010; 65: 384-390. doi: 10.1136/thx.2009.126722.
Damera G., Panettieri R.A. Does airway smooth muscle express an inflammatory phenotype in asthma? Br. J. Pharmacol. 2011; 163 (1): 68-80. DOI:10.1111/j.1476-5381.2010.01165.x
Fahy J. Eosinophilic and neutrophilic inflammation in asthma. Insights from clinical studies Proc. Am. Thoracic Soc. 2009; 6:256-259. doi: 10.1513/pats.200808-087RM.
Pederse F., Holz O., Kanniess F., Zielen S. et al. Longitudinal measurement of airway inflammation over one year in children and adults with intermittent asthma BMC Research Notes. 2014; 7: 925-933. doi:10.1186/1756-0500-7-925
Wong G.W.K., Kwon N., Hong J.G. et al. Pediatric asthma control in Asia: Phase 2 of the Asthma Insights and Reality in Asia-Pacific (AIRIAP 2) survey Allergy. 2013; 68: 524-530. DOI: 10.1111/all.12117
Stanford R.H., Gilsenan A.W., Ziemiecki R. et al. Predictors of uncontrolled asthma in adult and pediatric patients: analysis of the Asthma Control Characteristics and Prevalence Survey Studies (ACCESS) J. Asthma. 2010; 47: 257-262. DOI: 10.3109/02770900903584019
- There are currently no refbacks.
Copyright (c) 2016 CHILD`S HEALTH
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2017