Assessment of airway hyperreactivity: comparison of forced spirometry and body plethysmography for methacholine challenge tests

Abstract

Introduction: Bronchial challenge tests by inhalation of aerosolized methacholine (MCH) are commonly used in the clinical diagnosis of airway hyperresponsiveness (AHR). While the detection of airway narrowing relies on the patient's cooperation performing forced spirometry, body plethysmographic measurements of airway resistance are less depending on the patient's cooperation and do not alter the respiratory tract by maximal maneuvers. Hence we compared both methods concerning their clinical value and correlation during MCH challenges in patients with asthma.

Material and methods: Cumulative MCH challenges test, consisting of up to 5 steps, evaluated with body plethysmography on each step were performed in 155 patients with bronchial asthma. Airway responses were recorded at each step of MCH application (MasterScreen Body, Cardinal Health, Höchberg). At the baseline test and after crossing the provocation dose (PD) threshold in body plethysmography (PD+100 sReff), forced expirations were performed and FEV(1), FVC, and FEV(1) %FVC were measured. Using regression analysis of the airway parameters and taking the MCH dose as the covariate, we could extrapolate to missing spirometric values and interpolate the estimated MCH dose when crossing the PD threshold (PD-20 FEV(1)) between two consecutive measurements. The administered PD+100 MCH doses for specific airway resistance, sRtot, and sReff were compared with resistance parameters Rtot and Reff, and to PD-20 of FEV(1) and FEV(1) %FVC.

Results: Regarding sReff we found a mild, moderate, or severe AHR in 114 patients (75%), but only 50 (32%) according to FEV1. A statistical analysis showed strongly linear correlated parameters of airway resistance, but no significant correlation between the results of body plethysmography and forced spirometry.

Conclusions: Using MCH challenges, we found specific airway resistance to be the most sensitive parameter to detect AHR. Raw is largely independent of height and gender facilitating the interpretation of measurements carried out longitudinally.

Figure 1

Number of patients with MCH responses, classified as severe, moderate, mild, and normal, based on PD+100 for sReff, sRtot, Reff, Rtot, PD-40 for sGeff and sGRtot and PD-20 for FEV₁.

Figure 2

Accuracy of responses classified as severe, moderate, mild and normal, based on PD+100 for sReff, sRtot, Reff, Rtot, PD-40 for sGeff and sGRtot, and PD-20 for FEV₁.

Figure 3

Correlation of PD+100 sRtot and PD+100 sReff in cumulative MCH challenge testing inpatients with mild asthma.

Figure 4

Correlation of PD+100 sReff and of PD-20 FEV₁ in cumulative MCH challenge tests in patients with mild asthma.