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Lung auscultation in airway challenge testing
A Purohit1, A Bohadana, M C Kopferschmitt-Kubler
1Service de Pneumologie, Hôpital Civil, Hôpitaux Universitaires, Strasbourg, France.
Respiratory Medicine
|March 1, 1997
Summary
Lung auscultation, including wheezes and breath sound intensity changes, can effectively identify airway hyper-responsiveness (AH) during methacholine challenge tests (MCT). This method complements spirometry in diagnosing AH, offering a valuable tool alongside traditional FEV1 measurements.
Area of Science:
- Pulmonary Medicine
- Respiratory Physiology
- Diagnostic Tools
Background:
- Airway hyper-responsiveness (AH) is a key feature of obstructive airway diseases.
- Methacholine challenge testing (MCT) with spirometry is standard for diagnosing AH.
- Objective measures for AH detection during MCT are continually being refined.
Purpose of the Study:
- To evaluate the utility of lung auscultation in detecting airway hyper-responsiveness (AH) during methacholine challenge tests (MCT).
- To compare auscultation findings (wheezes, breath sound intensity) with spirometry results (FEV1) and patient-reported symptoms.
- To assess the reliability of lung auscultation as a diagnostic marker for AH.
Main Methods:
- Fifty-four patients undergoing routine MCT were monitored for wheezes and changes in breath sound intensity (BSI).
- Spirometry was performed before and after cumulative methacholine doses, with a 20% fall in FEV1 defining a positive test.
- Lung auscultation was conducted simultaneously by two observers, with symptoms recorded on a visual analogue scale.
Main Results:
- In the positive MCT group (MCT+), 20 out of 27 patients exhibited wheezes or diminished BSI, often preceding the spirometric endpoint (PD20).
- In the negative MCT group (MCT-), abnormal auscultation findings were less frequent.
- High inter-observer agreement (95.7%) was achieved for lung auscultation, with a Kappa coefficient of 0.846.
Conclusions:
- Lung auscultation, detecting wheezes and altered breath sound intensity, is a valuable adjunct to spirometry in MCT for identifying airway hyper-responsiveness.
- These auscultatory findings can manifest earlier than the spirometric criteria for AH.
- Acceptance of auscultation findings as legitimate indicators of AH, alongside FEV1 changes, can enhance diagnostic capabilities in respiratory challenge testing.