scholarly journals Bronchial provocation tests in clinical practice

2011 ◽  
Vol 129 (4) ◽  
pp. 243-249 ◽  
Author(s):  
Marcos de Carvalho Borges ◽  
Erica Ferraz ◽  
Elcio Oliveira Vianna
Keyword(s):  
Clinical Practice ◽  
Bronchial Hyperresponsiveness ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Bronchial Challenge ◽  
Cough Variant Asthma ◽  
Asthmatic Patients ◽  
Provocation Tests ◽  
Bronchial Provocation Tests ◽  
Bronchial Provocation

Bronchial hyperresponsiveness, which consists of an exaggerated response of the airways to bronchoconstrictor stimuli, is one of the main characteristics of asthma, presented in nearly all asthmatic patients. Bronchial hyperresponsiveness may also be present in other diseases, such as allergic rhinitis, chronic obstructive pulmonary disease, cystic fibrosis, heart failure and respiratory infection, and with some medications, such as β-blockers. Bronchial provocation tests (also known as bronchial challenges) are used to evaluate bronchial responsiveness. These tests have become increasingly used over the last 20 years, with the development and validation of accurate, safe and reproducible tests, and with the publication of well-detailed protocols. Several stimuli can be used in a bronchial challenge, and they are classified as direct and indirect stimuli. There are many indications for a bronchial challenge. In this review, we discuss the main differences between direct and indirect stimuli, and the use of bronchial challenges in clinical practice, especially for confirming diagnoses of asthma, exercise-induced bronchoconstriction and cough-variant asthma, and for use among elite-level athletes.

scholarly journals Common and Novel Markers for Measuring Inflammation and Oxidative Stress Ex Vivo in Research and Clinical Practice—Which to Use Regarding Disease Outcomes?

Antioxidants ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 414
Author(s):  
Alain Menzel ◽  
Hanen Samouda ◽  
Francois Dohet ◽  
Suva Loap ◽  
Mohammed S. Ellulu ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Clinical Practice ◽  
Acute Phase Proteins ◽  
Ex Vivo ◽  
Chronic Obstructive ◽  
Low Grade ◽  
Obstructive Pulmonary Disease ◽  
Amyloid A ◽  
Non Invasive ◽  
Markers Of Inflammation

Many chronic conditions such as cancer, chronic obstructive pulmonary disease, type-2 diabetes, obesity, peripheral/coronary artery disease and auto-immune diseases are associated with low-grade inflammation. Closely related to inflammation is oxidative stress (OS), which can be either causal or secondary to inflammation. While a low level of OS is physiological, chronically increased OS is deleterious. Therefore, valid biomarkers of these signalling pathways may enable detection and following progression of OS/inflammation as well as to evaluate treatment efficacy. Such biomarkers should be stable and obtainable through non-invasive methods and their determination should be affordable and easy. The most frequently used inflammatory markers include acute-phase proteins, essentially CRP, serum amyloid A, fibrinogen and procalcitonin, and cytokines, predominantly TNFα, interleukins 1β, 6, 8, 10 and 12 and their receptors and IFNγ. Some cytokines appear to be disease-specific. Conversely, OS—being ubiquitous—and its biomarkers appear less disease or tissue-specific. These include lipid peroxidation products, e.g., F2-isoprostanes and malondialdehyde, DNA breakdown products (e.g., 8-OH-dG), protein adducts (e.g., carbonylated proteins), or antioxidant status. More novel markers include also –omics related ones, as well as non-invasive, questionnaire-based measures, such as the dietary inflammatory-index (DII), but their link to biological responses may be variable. Nevertheless, many of these markers have been clearly related to a number of diseases. However, their use in clinical practice is often limited, due to lacking analytical or clinical validation, or technical challenges. In this review, we strive to highlight frequently employed and useful markers of inflammation-related OS, including novel promising markers.

scholarly journals Small airway dysfunction in patients with cough variant asthma: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jie Gao ◽  
Haigui Wu ◽  
Feng Wu
Keyword(s):  
Retrospective Cohort ◽  
Bronchial Hyperresponsiveness ◽  
Diagnostic Value ◽  
Small Airway ◽  
Small Airways ◽  
Cough Variant Asthma ◽  
Asthmatic Patients ◽  
Cell Test ◽  
Sputum Eosinophils ◽  
The Relationship

Abstract Background Cough variant asthma (CVA) is one of the special populations of asthma. The aim of the study was to compare small airways, the degree of bronchial hyperresponsiveness (BHR) and airway inflammatory subtypes between CVA and classic asthma (CA), and investigate the relationship between these markers to determine the accuracy as indicators of CVA. Methods A total of 825 asthmatic patients participated in the study and 614 were included. 614 patients underwent spirometry and a bronchial challenge with methacholine and 459 patients performed induction sputum cell test. Results The number of CVA patients showed less small airway dysfunction than those of CA patients (p < 0.005). The degree of small airways dysfunction was higher in the CA group compared with the CVA group (p < 0.001). Small airways dysfunction was severer in the eosinophilic airway inflammatory subtype compared with other subtypes (p < 0.05).The area under curve of MMEF, FEF50 and FEF75 (% predicted) was 0.615, 0.621, 0.606, respectively. 0.17mcg of PD20 and 4.7% of sputum eosinophils was the best diagnostic value for CVA with an AUC of 0.582 and 0.575 (p = 0.001 and p = 0.005, respectively). Conclusions The eosinophilic airway inflammatory subtype may be increased small airway dysfunction. The value of small airways, BHR and induction sputum cells in CVA prediction, which reflected significant, but not enough to be clinically useful.

scholarly journals Cartography of Emergency Department Visits for Asthma – Targeting High-Morbidity Populations

2004 ◽  
Vol 11 (6) ◽  
pp. 427-433 ◽  
Author(s):  
Pierre Lajoie ◽  
Andrée Laberge ◽  
Germain Lebel ◽  
Louis-Philippe Boulet ◽  
Marie Demers ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Visits ◽  
Administrative Database ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Age Group ◽  
Obstructive Pulmonary Disease ◽  
Asthmatic Patients ◽  
South Central ◽  
Ed Visits

BACKGROUND:Asthma education should be offered with priority to populations with the highest asthma-related morbidity. In the present study, the aim was to identify populations with high-morbidity for asthma from the Quebec Health Insurance Board Registry, a large administrative database, to help the Quebec Asthma and Chronic Obstructive Pulmonary Disease Network target its interventions.METHODS:All emergency department (ED) visits for asthma were analyzed over a one-year period, considering individual and medical variables. Age- and sex-adjusted rates, as well as standardized rate ratios related to the overall Quebec rate, among persons zero to four years of age and five to 44 years of age were determined for 15 regions and 163 areas served by Centres Locaux de Services Communautaires (CLSC). The areas with rates 50% to 300% higher (P<0.01) than the provincial rate were defined as high-morbidity areas. Maps of all CLSC areas were generated for the above parameters.RESULTS:There were 102,551 ED visits recorded for asthma, of which more than 40% were revisits. Twenty-one CLSCs and 32 CLSCs were high-morbidity areas for the zero to four years age group and five to 44 years age group, respectively. For the most part, the high-morbidity areas were located in the south-central region of Quebec. Only 47% of asthmatic patients seen in ED had also seen a physician in ambulatory care.CONCLUSION:The data suggest that a significant portion of the population seeking care at the ED is undiagnosed and undertreated. A map of high-morbidity areas that could help target interventions to improve asthma care and outcomes is proposed.

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