Differences in responsiveness of asthmatic airways to direct and ındirect stimuli
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Date
2003
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AVES
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info:eu-repo/semantics/openAccess
Abstract
Artmış hava yolu yanıtlılığı astımın temel fizyopatolojik özelliklerinden biridir. Klinikte direkt bir uyaran olan metakolin ile bronkoprovokasyon en sık kullanılan testtir. Ancak adenozin monofosfat (AMP) gibi indirekt uyaranların, astımın fizyopatolojisi ile daha yakın ilişkili olması nedeniyle daha duyarlı ve özgül olabilecekleri düşünülmektedir. Astımda bir indirekt uyaran olan AMP ile bronkoprovokasyonun metakoline tanısal üstünlüğü araştırıldı. 19'u kadın, 3'ü erkek, yaş ortalamaları 34.77±15.38 yıl olan 22 astımlı ile 11'i sigara içmeyen 10'u sigara içen sağlıklı kontrollere metakolin (0.0625-64 mg/mL) ve AMP (0.004-800 mg/mL) bronkoprovokasyonu uygulandı. Her provokasyon için özgüllük ve duyarlılık eğrileri çakıştırılarak astımı sağlıklılardan ayıran "cut-off" değerleri belirlendi. Ortalama PC20 metakolin astımlılarda 3.39±5.02 mg/mL, sigara içenlerde 39.17±22.23 mg/mL, sigara içmeyenlerde 57.66±15.28 mg/mL; PC20 AMP ise astımlılarda 44.73±85.30 mg/mL, sigara içen ve içmeyenlerde 800±0 mg/mL olarak bulundu. Özgüllük ve duyarlılık eğrileri çakıştırıldığında metakolin, astımlıları sigara içenlerden %94, sigara içmeyenlerden %96 özgüllük ve duyarlılık ile sırasıyla 6.8 mg/mL ve 13 mg/mL konsantrasyonlarında ayırdı. AMP ise astımlıları hem sigara içen hem de içmeyen sağlıklılardan %100 özgüllük ve duyarlılık ile 100 mg/mL'de ayırdı . AMP ile bronkoprovokasyonun inflamasyonun bir göstergesi olarak astımlıları sigara içen ve içmeyen sağlıklılardan ayırmada metakoline göre daha değerli olduğu düşünüldü.
Increased bronchial hyperresponsiveness (BHR) is an essential feature of asthma. In clinical studies methacholine challenge is generally used to measure BHR. However, adenosine monophosphate (AMP) - an indirect stimulus- has been suggested to be a better marker for airway inflammation since it is more closely related with asthmatic inflammatory processes. In order to assess the responsiveness of asthmatic airways to AMP and compare its diagnostic value with respect to methacholine challenge we performed methacholine and AMP bronchoprovocation tests in 22 asthmatics (19 women, 3 men; median age 34.77±15.38 yrs), 10 smoker and 11 nonsmoker healthy volunteers. For each type of challenge, sensitivity and specificity curves were constructed. Intersection points of these curves were used as cut-off points in differentiating asthmatics from controls. The median PC 20" values were as follows: asthmatics 3.39±5.02 mg/mL, smokers 39.17±22.23 mg/mL, nonsmokers 57.66±15.28 mg/mL for methacholine; asthmatics 44.73±85.30 mg/mL, smokers and nonsmokers 800±0 mg/ml for AMP. Methacholine distinguished asthmatics from smokers and nonsmokers with a sensitivity and specificity of 94%-96% at 6.8 mg/ml and 13 mg/mL concentrations, respectively. AMP distinguished asthmatics from both controls at 100 mg/mL concentration with 100% sensitivity and specificity. In our study population A MP bronchoprovocation was found to be a more appropriate screening test and inflammatory marker differentiating asthma from healthy controls.
Increased bronchial hyperresponsiveness (BHR) is an essential feature of asthma. In clinical studies methacholine challenge is generally used to measure BHR. However, adenosine monophosphate (AMP) - an indirect stimulus- has been suggested to be a better marker for airway inflammation since it is more closely related with asthmatic inflammatory processes. In order to assess the responsiveness of asthmatic airways to AMP and compare its diagnostic value with respect to methacholine challenge we performed methacholine and AMP bronchoprovocation tests in 22 asthmatics (19 women, 3 men; median age 34.77±15.38 yrs), 10 smoker and 11 nonsmoker healthy volunteers. For each type of challenge, sensitivity and specificity curves were constructed. Intersection points of these curves were used as cut-off points in differentiating asthmatics from controls. The median PC 20" values were as follows: asthmatics 3.39±5.02 mg/mL, smokers 39.17±22.23 mg/mL, nonsmokers 57.66±15.28 mg/mL for methacholine; asthmatics 44.73±85.30 mg/mL, smokers and nonsmokers 800±0 mg/ml for AMP. Methacholine distinguished asthmatics from smokers and nonsmokers with a sensitivity and specificity of 94%-96% at 6.8 mg/ml and 13 mg/mL concentrations, respectively. AMP distinguished asthmatics from both controls at 100 mg/mL concentration with 100% sensitivity and specificity. In our study population A MP bronchoprovocation was found to be a more appropriate screening test and inflammatory marker differentiating asthma from healthy controls.
Description
Keywords
Duyarlılık ve özgüllük, Adenozin monofosfat, Hava yolu tıkanıklığı, Metakolin klorid, Sigara içme, Astım, Sensitivity and Specificity, Adenosine Monophosphate, Airway Obstruction, Methacholine Chloride, Smoking, Asthma
Journal or Series
Toraks Dergisi
WoS Q Value
Scopus Q Value
Volume
4
Issue
2
Citation
Karaağaç, G., Çelik, N., Başlılar, Ş. ve Yılmaz, T. (2003). Differences in responsiveness of asthmatic airways to direct and ındirect stimuli / Astımda direkt ve indirekt uyaranlara yanıt farklılıkları. Toraks Dergisi, AVES. 4(2), s. 161-167.
