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[Bronchial hyperreactivity to distilled water]
M Studnicka1, T Frischer, M Neumann
1Erste Abteilung am Pulmologischen Zentrum, Wien.
Insights
Distilled water inhalation challenges identified a strong association with asthma in children. This safe and simple method may serve as an alternative to methacholine provocation testing for asthma diagnosis.
Area of Science:
- Pediatric Pulmonology
- Clinical Allergy and Immunology
- Respiratory Medicine
Context:
- Asthma diagnosis in children often relies on provocative testing.
- Methacholine provocation testing is a standard but can have limitations.
- Alternative, safer provocation methods are needed for pediatric populations.
Purpose:
- To evaluate the efficacy and safety of distilled water aerosol inhalation as a provocative challenge test for asthma in children.
- To compare the results of distilled water challenge with asthma diagnosis and other relevant symptoms.
Summary:
- An epidemiological study involved 446 children undergoing a 10-minute tidal inhalation of ultrasonically nebulized distilled water.
- Children with a clinical asthma diagnosis showed significantly higher odds (OR=9.1) of a positive challenge test compared to non-asthmatics.
- Cough, nocturnal cough, and atopy (via prick testing) were significantly associated with positive distilled water challenges.
Impact:
- Distilled water challenge presents a simple, safe, and potentially effective alternative to methacholine provocation for diagnosing asthma in children.
- This method offers a pathophysiologically relevant stimulus with minimal side effects.
- Findings support the use of distilled water inhalation in epidemiological studies and potentially in clinical settings for asthma assessment.
Abstract:
For an epidemiological study 446 children were challenged with distilled water. The protocol consisted of 10 minutes tidal inhalation of an ultrasonically nebulized aerosol of distilled water. For children presenting with a clinical diagnosis of asthma the odds ratio for a positive challenge test was 9.1 compared to non-asthmatics [95% confidence intervals: 2.4-34.9; p = 0.001]. Symptoms cough (p = 0.03), cough at night (p = 0.03) and atopy defined by prick-test (p = 0.001) were also significantly associated with a positive challenge. The easy conduct of our protocol, the--from a pathophysiological point of view--"close to asthma" stimulus, and the small number of side-effects, indicate that the challenge with distilled water can be regarded as an alternative to metacholine provocation testing.