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Asymptomatic bronchial hyperresponsiveness in rhinitis.

E H Ramsdale, M M Morris, R S Roberts

    The Journal of Allergy and Clinical Immunology
    |May 1, 1985
    PubMed
    Summary
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    Increased methacholine responsiveness in patients with rhinitis may indicate subclinical asthma, not a false positive. This bronchial hyperresponsiveness was confirmed using other tests in asymptomatic individuals.

    Area of Science:

    • Respiratory Medicine
    • Allergy and Immunology

    Background:

    • Methacholine inhalation testing aids asthma diagnosis when spirometry is normal.
    • The clinical significance of heightened methacholine responsiveness in rhinitis patients without asthma symptoms remains unclear.

    Purpose of the Study:

    • To investigate whether increased methacholine responsiveness in asymptomatic rhinitis patients signifies subclinical asthma or a false positive result.
    • To compare methacholine bronchial provocation with natural stimuli like cold air hyperventilation and diurnal peak flow variation.

    Main Methods:

    • Twenty-five rhinitis patients, without a physician-diagnosed asthma, underwent methacholine challenge testing.
    • Bronchial responsiveness was assessed by the provocative concentration causing a 20% fall in FEV1 (PC20).
    • Methacholine PC20 was compared with responses to isocapnic hyperventilation of cold air and diurnal peak flow rate variability.

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    Main Results:

    • Ten patients had a PC20 less than 16 mg/ml, indicating increased methacholine responsiveness.
    • Seven of these 10 patients showed objective evidence of variable airflow obstruction via hyperventilation or peak flow variability.
    • The remaining three patients had borderline increased PC20 values (8 to 16 mg/ml).

    Conclusions:

    • Increased methacholine responsiveness in rhinitis patients, even without asthma symptoms, is associated with objective evidence of variable airflow obstruction.
    • These findings suggest that heightened methacholine responsiveness in this population often indicates subclinical asthma rather than a false positive test.
    • The study validates methacholine challenge as a useful tool for identifying potential subclinical asthma in patients with allergic rhinitis.