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How many spirograms for a histamine challenge?

G C Scott, M Küng

    The American Review of Respiratory Disease
    |August 1, 1985
    PubMed
    Summary
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    A deep breath can blunt airway constriction from medication. Performing two FEV1 tests during histamine challenges showed the second test was higher, suggesting one test per dose is best for accuracy.

    Area of Science:

    • Pulmonary Medicine
    • Respiratory Physiology

    Background:

    • Deep inspiration can reduce pharmacologically induced bronchoconstriction.
    • FEV1 (Forced Expiratory Volume in 1 second) determination requires full lung inflation, potentially masking obstruction.

    Purpose of the Study:

    • To evaluate the impact of two consecutive FEV1 maneuvers on interpreting histamine-induced bronchoconstriction.
    • To assess if repeated FEV1 measurements influence the perceived severity of airway obstruction.

    Main Methods:

    • Eight non-smoking asthmatics underwent 16 histamine challenges.
    • Paired FEV1 measurements (FEV1_1, FEV1_2) were recorded after buffer and serial histamine doses.
    • Airway response defined as a 20% decrease in FEV1 from baseline.

    Main Results:

    Related Experiment Videos

    • All subjects showed histamine airway hypersensitivity at doses ≤5 mg/ml.
    • FEV1_2 was consistently higher than FEV1_1 at higher histamine doses (p=0.007).
    • The difference (FEV1_2 - FEV1_1) correlated with cumulative histamine dose (p=0.040).

    Conclusions:

    • A prior deep inspiration can influence FEV1 measurements during bronchoconstriction challenges.
    • Performing two FEV1 maneuvers may lead to underestimation of airway obstruction severity.
    • Recommends performing only one spirogram per induced bronchoconstriction level in histamine challenges.