NDLI: Methacholine challenge test: diagnostic characteristics in asthmatic patients receiving controller medications.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Sumino, Kaharu Sugar, Elizabeth A. Irvin, Charles G. Kaminsky, David A. Shade, Dave Wei, Christine Y. Holbrook, Janet T. Wise, Robert A. Castro, Mario
Organization	American Lung Association Asthma Clinical Research Centers
Description	Country affiliation: United States Author Affiliation: Sumino K ( Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO 63110, USA. ksumino@dom.wustl.edu)
Abstract	BACKGROUND: The methacholine challenge test (MCT) is commonly used to assess airway hyperresponsiveness, but the diagnostic characteristics have not been well studied in asthmatic patients receiving controller medications after the use of high-potency inhaled corticosteroids became common. OBJECTIVES: We investigated the ability of the MCT to differentiate participants with a physician's diagnosis of asthma from nonasthmatic participants. METHODS: We conducted a cohort-control study in asthmatic participants (n= 126) who were receiving regular controller medications and nonasthmatic control participants (n= 93) to evaluate the sensitivity and specificity of the MCT. RESULTS: The overall sensitivity was 77% and the specificity was 96% with a threshold PC(20) (the provocative concentration of methacholine that results in a 20% drop in FEV(1)) of 8 mg/mL. The sensitivity was significantly lower in white than in African American participants (69% vs 95%, P= .015) and higher in atopic compared with nonatopic (82% vs 52%, P= .005). Increasing the PC(20) threshold from 8 to 16 mg/mL did not noticeably improve the performance characteristics of the test. African American race, presence of atopy, and lower percent predicted FEV(1) were associated with a positive test result. CONCLUSIONS: The utility of the MCT to rule out a diagnosis of asthma depends on racial and atopic characteristics. Clinicians should take into account the reduced sensitivity of the MCT in white and nonatopic asthmatic patients when using this test for the diagnosis of asthma.
File Format	HTM / HTML
ISSN	00916749
e-ISSN	10976825
Journal	Journal of Allergy and Clinical Immunology
Issue Number	1
Volume Number	130
Language	English
Publisher	Elsevier
Publisher Date	2012-07-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Immunology Adrenal Cortex Hormones Therapeutic Use Anti-asthmatic Agents Asthma Drug Therapy Bronchial Provocation Tests Methacholine Chloride Adolescent Diagnosis Bronchial Hyperreactivity Cohort Studies Cross-sectional Studies Forced Expiratory Volume Predictive Value Of Tests Respiratory Function Tests Sensitivity And Specificity Clinical Trial Multicenter Study Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Immunology and Allergy Immunology

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