Comparison of adenosine 5'-monophosphate and methacholine for the differentiation of asthma from chronic airway diseases with the use of the auscultative method in very young children☆,☆☆,★
Section snippets
METHODS
Thirty-nine children (mean age ± SD, 4.3 ± 1.4 years) who met the American Thoracic Society's diagnostic criteria for asthma9 and 15 children (mean age, 4.4 ± 1.5 years) with other chronic airway diseases participated in the study. The latter group included 5 children with recurrent upper respiratory tract infection and chronic cough unresponsive to antiasthma treatment, 5 with recurrent pneumonia, 3 with bronchiolitis obliterans, and 2 with cystic fibrosis. All patients avoided bronchodilator
RESULTS
There was no significant difference (p = 0.75) between the mean age of the children with asthma and that of the CAD group. The logarithmic mean PCW to methacholine in subjects with asthma (0.36 mg/ml, range 0.12 to 1.08 mg/ml) was not significantly different (p = 0.82) from that in the CAD group (0.39 mg/ml, range 0.09 to 1.66 mg/ml). The logarithmic mean PCW to adenosine in children with asthma (8.3 mg/ml, range 1.8 to 37.8 mg/ml) was significantly (p < 0.00001) smaller than that in the CAD
DISCUSSION
Methacholine has been widely used for the detection and quantitation of bronchial hyperreactivity in bronchial asthma. All patients with active disease react to less than 8 mg/ml of histamine or methacholine.1 In the present study, all children in both groups reacted similarly to methacholine with a PCW less than 8 mg/ml. Similar results were found in our previous study with older children and young adults with the use of a conventional challenge technique.8
During the adenosine challenge, most
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Cited by (33)
Exercise and Lung Function in Child Health and Disease
2012, Kendig and Chernick's Disorders of the Respiratory Tract in ChildrenApplication of a shortened inhaled adenosine-5′-monophosphate challenge in young children using the forced oscillation technique
2009, ChestCitation Excerpt :With regard to the response to the shortened AMP challenge, neither of the two children without asthma responded, 50% of the children with past wheeze responded (3 of 6 children), and 86% of children with persistent wheeze (25 of 29 children) responded. Previous studies4 using a standard (long) AMP challenge test and wheeze on auscultation in young children have reported a concentration of 200 mg/mL as having 52% sensitivity and 87% specificity for distinguishing clinical asthma from other chronic lung diseases, whereas Kim et al,5 who used an identical protocol, reported sensitivity and specificity levels of 84% and 68%, respectively, to distinguish between atopic and nonatopic 4- to 6-year-old children with wheezing. Further research in larger studies of young children both with and without respiratory disease are required to test the relevance of this cutoff level to a shortened AMP challenge using FOT as an outcome measure.
Respiratory function assessment in cooperative patients. Part II
2007, Anales de PediatriaPulmonary Function Assessment in the Laboratory during Exercise
2006, Kendig's Disorders of the Respiratory Tract in ChildrenAdenosine bronchial provocation with computerized wheeze detection in young infants with prolonged cough: Correlation with long-term follow-up
2004, ChestCitation Excerpt :A comparison of adenosine concentration at positive response by CWD vs auscultation was performed using a paired t test following logarithmic transformation. BPTs were performed by the inhalation of nebulized solutions of adenosine 5′-monophosphate (adenosine) in doubling doses.7 Fresh solutions of adenosine (Sigma Chemical Company; St. Louis, MO) were prepared, starting at 0.39 mg/mL to a maximum of 200 mg/mL.
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From the Institute of Pulmonology, Hadassah University Hospital, Jerusalem, Israel
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Reprint requests: A. Avital, MD, Institute of Pulmonology, Hadassah University Hospital, PO Box 12000, Jerusalem, Israel.
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