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Response to bronchial provocation and exercise in children with cystic fibrosis
Insights
Cystic fibrosis children often show bronchial allergy to inhaled antigens like Aspergillus fumigatus. This allergy doesn't fully explain asthma, suggesting other factors are involved in cystic fibrosis respiratory issues.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Cystic fibrosis (CF) patients exhibit unique respiratory challenges.
- The role of bronchial allergy in CF-related respiratory symptoms requires further elucidation.
- Asthma susceptibility in CF is not fully understood.
Purpose of the Study:
- To investigate bronchial allergic responses in children with cystic fibrosis.
- To assess the relationship between bronchial allergy and asthma development in CF patients.
- To explore exercise-induced bronchial reactivity patterns in CF.
Main Methods:
- Skin prick tests were performed on 15 children with cystic fibrosis.
- Bronchial challenge tests with common antigens were administered.
- Peak Expiratory Flow Rate (PEFR) was monitored during exercise challenges.
Main Results:
- Ten of fifteen CF children had positive skin tests and immediate bronchial reactions to inhaled antigens.
- Five children experienced late bronchial reactions; only one reported a history of asthma.
- Aspergillus fumigatus was the most common antigen eliciting positive skin reactions; bronchial responses varied.
- CF children did not exhibit the typical asthma exercise response; two showed an abnormal PEFR rise during exercise.
Conclusions:
- Bronchial allergy (immediate or late) does not solely explain asthma susceptibility in cystic fibrosis.
- Other factors, potentially including specific exercise-induced bronchial reactivity, may contribute to asthma development.
- The prevalence of bronchial allergy in CF suggests anti-allergy therapies may benefit selected patients.
Abstract:
Ten of fifteen cystic fibrosis children with positive skin prick tests to common antigens gave an immediate bronchial reaction to the antigen inhaled, five of them also gave a late reaction; however only one gave a history of asthma. The antigen most commonly eliciting a positive skin reaction in cystic fibrosis patients is Aspergillus fumigatus. In six children tested to this antigen the bronchial response varied, two were negative, one gave an immediate reaction and three gave a dual (immediate and late) reaction. None of the children showed the characteristic pattern of response to exercise seen in asthmatic patients, an initial rise in Peak Expiratory Flow Rate followed by a fall of greater than 14% below the resting level. Two patients showed an abnormal rise in Peak Expiratory Flow Rate during exercise, a pattern described previously in cystic fibrosis. The results suggest that bronchial allergy, immediate or late does completely explain susceptibility to asthma, and that other factors including perhaps the type of bronchial reactivity shown by bronchoconstriction after exercise may be required. However the majority of the children tested had bronchial allergy and anti-allergy therapy such as inhaled sodium cromoglycate may have a place in the management of selected patients with cystic fibrosis.