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Related Experiment Videos

Testing bronchial hyper-responsiveness: provocation or peak expiratory flow variability?

J J den Otter1, G M Reijnen, W J van den Bosch

  • 1Department of General Practice and Social Medicine, Nijmegen University, The Netherlands.

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
|August 1, 1997
PubMed
Summary
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Peak expiratory flow (PEF) variability is not a reliable substitute for bronchial provocation testing in diagnosing asthma. Histamine challenge tests are necessary for accurate assessment of bronchial hyper-responsiveness (BHR).

Area of Science:

  • Pulmonary Medicine
  • Diagnostic Accuracy
  • Respiratory Physiology

Background:

  • Assessing bronchial hyper-responsiveness (BHR) is crucial for asthma diagnosis.
  • Peak expiratory flow (PEF) variability is proposed as a practical alternative to provocation testing in general practice.
  • This study evaluates the agreement between histamine challenge testing and PEF variability for BHR assessment.

Purpose of the Study:

  • To investigate the utility of PEF variability in assessing BHR.
  • To compare PEF variability with histamine provocation testing as a reference standard for BHR.
  • To determine the implications of using PEF variability for asthma diagnosis.

Main Methods:

  • 323 subjects with asthma symptoms underwent histamine provocation testing and PEF variability assessment over three weeks.

Related Experiment Videos

  • Asthma was defined by symptoms, reversible airflow obstruction, or BHR to histamine.
  • BHR was defined by PC20 histamine ≤ 8 mg/ml or PEF variability ≥ 15%.

    • Main Results:

    • A poor correlation (Spearman's rho = -0.27) was found between PC20 histamine and PEF variability.
    • Only 11 patients met the criteria for BHR based on PEF variability.
    • 114 out of 131 patients diagnosed with asthma via histamine challenge were not diagnosed using PEF variability.

    Conclusions:

    • PEF variability is not a suitable replacement for bronchial provocation testing in assessing BHR.
    • PEF variability and bronchial provocation assess different aspects of BHR.
    • Bronchial provocation testing remains essential for diagnosing asthma when BHR assessment is required in general practice.