黄芪党参甘草等中药降低气道反应性的研究

目的探讨黄芪、党参、甘草等中药降低气道反应性的作用。方法对２８例哮喘患者治疗前测定用力肺活量（ＦＶＣ），一秒钟用力呼气容积（ＦＥＶ１），高峰呼气流速（ＰＥＦ），并用乙酰甲胆碱（Ｍｃｈ）累积量０．０３３μｍｏｌ和１．９８μｍｏｌ进行激发试验，用黄芪、党参、甘草等中药治疗６周后，再次测定这组患者的三项指标，然后进行治疗前后的对比分析。结果２８例患者经黄芪、党参、甘草等治疗后，ＦＶＣ显著增加（３４±０２～３５±０２Ｌ，Ｐ＜０．０５），且ＦＥＶ１（２３±０１～２６±０１）、ＰＥＦ（４９±０３～５３±０３）的增加均具有高度显著性意义（Ｐ＜０．０１）。结论黄芪、党参、甘草等中药能够降低哮喘患者气道反应性。     

吸入一氧化氮与沙丁胺醇对哮喘患者肺功能的影响

为探讨吸入一氧化氮（ＮＯ）与吸入沙丁胺醇（Ｖｅｎｔｏｌｉｎ）对支气管哮喘患者肺功能的影响。９例哮喘患者（其中组织胺激发试验阳性者５例）先后吸入２００～４００μｇ的Ｖｅｎｔｏｌｉｎ及１０ｐｐｍＮＯ观察吸入后通气功能的变化，结果显示，吸入Ｖｅｎｔｏｌｉｎ可使患者ＦＶＣ，ＦＥＶ１，ＦＥＶ１／ＦＶＣ，ＰＥＦ，ＭＭＥＦ，Ｖ５０得到明显改善；吸入ＮＯ后患者ＦＶＣ，ＦＥＶ１，ＰＥＦ明显增量ＦＥＶ１的增加幅度不及     

支气管哮喘患者血浆内皮素1含量及临床意义

采用特异性放射免疫技术测定了２８例支气管哮喘急性发作（发作组）、２２例支气管哮喘临床控制（缓解组）和２０名健康对照者（对照组）的血浆内皮素１（ＥＴ１）含量。结果显示：发作组血浆含量（１３．４±５．２ｐｍｏｌ／Ｌ）分别显著高于缓解组（８．４±３．９ｐｍｏｌ／Ｌ，Ｐ＜０．０１）和对照组（６．６±２．６ｐｍｏｌ／Ｌ，Ｐ＜０．０１）；而缓解组与对照组间的差异无显著性；发作组血浆ＥＴ１含量分别与血氧分压（ＰａＯ＿２）和一秒钟用力呼气容积占用力肺活量比值（ＦＥＶ＿１％）呈显著负相关（ｒ＝－０．８２５７，ｒ＝－０．８１５７，Ｐ＜０．０１）。上述结果提示ＥＴ１可能涉及到支气管哮喘急性发作的病理生理过程。     

溴化异丙托品与沙丁胺醇雾化吸入对COPD病人的支气管扩张作用

以随机公开对照试验比起对ＣＯＰＤ病人的支气管扩张作用及副作用．雾化吸入沙丁胺醇（５００μｇ）为Ａ组１６例；雾化吸入溴优异丙托品（５０μｇ）为Ｂ组１５例，雾化吸入沙丁胺醇（５０μｇ）合并异丙托品（５００μｇ）为Ｃ组１５例。结果：Ａ组１５分钟起效；Ｂ组６０分钟起效，其ＦＥＶ１（第一秒用力肺活量）及ＦＶＣ（用力肺活量）的最大改善率（２２．０％、２２．７％）与Ａ给（２１．５％、２３．２％）相比无差异（Ｐ＞０．０５），Ｃ组５、１５分钟ＦＥＶ１的改善率（８．７％、１３．０％）高于Ｂ组（０％、２％）；１８０、３６０分钟ＦＥＶ１的改善率为（２３．９％、１７．３％）高于Ａ组（１３．７％、５．８％）（Ｐ＜０．０５），ＦＶＣ与ＦＥＶ１的改变相近，三组均无严重的副反应。提示：ＣＯＰＤ患者雾化吸入异丙托品具有与沙丁胺醇相近的气道扩张作用．但起效慢．两者合用时，起效快，持续时间长，作用优于单药应用．     

慢性干咳伴有气道高反应性即是咳嗽变异性哮喘吗？

目的评价气道反应性测定在咳嗽变异性哮喘（ＣＶＡ）诊断中的价值。方法１２４例慢性干咳患者经气道反应性测定后，分为咳嗽气道高反应阳性组（ＣＢＨ－Ｐ组）３５例，咳嗽气道高反应阴性组（ＣＢＨ－Ｎ组）３３例。观察常规肺功能、抗原皮肤点刺试验阳性率、血嗜酸性粒细胞计数、血ＩｇＥ水平、泼尼松试验阳性率并随访２年后发展成典型哮喘例数。结果３５例ＣＢＨ－Ｐ组一秒钟用力呼气容积占用力肺活量比值（ＦＥＶ１％）为７４±１０（Ｐ＜０．０１），３３例ＣＢＨ－Ｎ组为８３±１０（Ｐ＜０．０５）。抗原皮肤点刺试验阳性率ＣＢＨ－Ｐ组为５１％，ＣＢＨ－Ｎ组为１２％；血嗜酸性粒细胞计数ＣＢＨ－Ｐ组为０．５±０．１×１０９／Ｌ，ＣＢＨ－Ｎ组为０．３±０．１×１０９／Ｌ；泼尼松试验阳性率ＣＢＨ－Ｐ组为８３％，ＣＢＨ－Ｎ组为１５％。随访２年后发展成典型哮喘例数中ＣＢＨ－Ｐ组有１６例发展成典型哮喘。在ＣＢＨ－Ｐ组中发展成典型哮喘与未发展成典型哮喘患者在皮肤抗原点刺试验阳性率、常规肺功能、反应阈值（Ｄｍｉｎ）及致喘阈值（Ｄｃｗ／Ｄｍｉｎ）等方面差异均无显著性。结论气道反应性测定是诊断ＣＶＡ的重要依据，但不是唯一的诊断标准，还应结合其它临床资料综合判断     

哮喘患者支气管肺泡灌洗液中血栓素A2,前列环素水平测定及其意义

对２６例发作期过敏性哮喘患者及１４例正常人支气管肺泡灌洗液（ＢＡＬＦ）中的血栓素Ｂ２，（ＴＸＢ２）６－酮－前列腺素Ｆ１α（６－ｋｅｔｏ－ＰＧＦ１α）水平进行了测定，并与患者肺功能进行相关分析，结果显示，哮喘患者ＢＡＬＦ中的ＴＸＢ２水平明显高于正常人，并与其１秒钟肺活量（ＦＥＶ１．０）肺活量５０％时的呼吸流速（Ｖ５０）呈明显负相关，６－ｋｅｔｏ－ＰＧＦ１α与正常人无差异，提示ＴＸＡ２在哮喘气道炎症中     

双盲对照吸入倍氯米松一年对气道高反应性与哮喘的防治作用

目的探讨长期吸入糖皮质激素对哮喘患者的治疗作用和对无症状的气道高反应性（ＢＨＲ）者发生哮喘的预防作用。方法以随机、双盲对照法比较５９例ＢＨＲ学生，年龄１２～１８岁，吸入倍氯米松干粉剂（ＢＤＰ，６００μｇ／ｄ）或安慰剂１年对气道反应性及哮喘症状的作用。结果试验１年后哮喘ＢＤＰ组气道高反应性（使ＦＥＶ１较基础值下降２０％的累积吸入组胺量的对数ｌｇＰＤ２０－ＦＥＶ１）显著下降（分别为０．３８５±０．４２４、１．１８７±０．６０３μｍｏｌ组胺，Ｐ＜０．０２），只有３０％哮喘者仍有喘息，而对照组则有８６％仍有喘息（Ｐ＝０．０７６）；无症状ＢＨＲ学生的ｌｇＰＤ２０－ＦＥＶ１在ＢＤＰ组及对照组间差异无显著性，但ＢＤＰ组不出现喘息症状，而对照组则有３例出现喘息（１５％）；ＢＨＲ者吸入ＢＤＰ组的累积症状计分显著低于对照组（分别为１．５０±２．５４分、５．５８±６．２２分，Ｐ＜０．０１）。结论ＢＤＰ能降低哮喘患者的ＢＨＲ及减轻其症状，且可能有预防无症状ＢＨＲ者发生哮喘的作用     

老年前列腺恶性增生切除睾丸后唾液表皮生长因子水平的变化

目的　探讨睾丸切除对人唾液表皮生长因子（ＥＧＦ） 分泌的影响。方法：应用放射免疫测定（ＲＩＡ） 方法对１１例因前列腺癌切除睾丸和２２ 例正常人唾液ＥＧＦ 含量进行了检测。结果：人睾丸切除后人唾液ＥＧＦ 含量１３－３２ ±４ ．３３（ｎｇ／１５ ｍｉｎ） ,与术前１４－０７ ±４ ．５０（ｎｇ／１５ ｍｉｎ） 比较,ｔ＝ １ ．７２５２ ,０ ．２ ＞ Ｐ＞ ０ ．１ ;与正常男性唾液ＥＧＦ 含量１３－９１ ±３ ．９０（ｎｇ／１５ｍｉｎ） 比较,ｔ ＝ ０ ．３９４６ ,Ｐ＞ ０ ．２５ ;均无显著性差别。结论：睾丸缺失对ＥＧＦ 影响不明显     

强迫振荡肺功能测定新技术及临床研究

目的探讨强迫振荡肺功能测定在正常人、慢性阻塞性肺疾病、哮喘、肺纤维化等患者中气道阻力和相位角的变化规律以及哮喘患者吸入支气管舒张剂前、后肺功能的变化。方法使用德国Ｃｕｓｔｏｖｉｔｍ强迫振荡设备，测定各患者组气道阻力和相位角，然后分别和正常组进行统计学比较；哮喘患者吸入间羟舒喘宁前、后气道阻力改善率与一秒钟用力呼气容积（ＦＥＶ１）和流速容量（ＦＶ）曲线测定改善率比较。结果慢性阻塞性肺疾患和哮喘组气道阻力值与正常组比较差异有显著性（Ｐ＜０．０５）及显著频率依赖性（Ｐ＜０．０５）；各病种组相位角与正常组比较差异有显著性（Ｐ＜０．０５），且肺纤维化患者仅表现为相位角降低；哮喘患者吸入间羟舒喘宁后气道阻力改善率与ＦＥＶ１和ＦＶ曲线改善率比较差异有显著性（Ｐ＜０．０５）。结论强迫振荡法是一种简便、快速、无创性测定气道阻力与相位角的新方法，适用于重症慢性阻塞性肺疾病患者，且对哮喘的用药观察优于传统肺功能测定。     

咳嗽变异型哮喘患者的肺功能及气道反应性特征

为探讨肺功能及气道反应性测定在诊断咳嗽变异型哮喘（ＣＶＡ）中的作用，用２２００型肺功能仪、６２００型体容积描计仪和ＡｓｔｏｇｒａｐｈＴＣＫ６１００气道反应测定仪检测了２２例典型哮喘患者、３５例ＣＶＡ患者和５１例正常健康者的肺功能及气道反应性。ＣＶＡ组的ＦＥＶ１／ＦＶＣ（％）（１秒钟用力呼气量占用力肺活量加百分比）高于哮喘组（Ｐ＜００１），但与正常组无差异（Ｐ＞００５）；Ｒａｗ（气道阻力）明显低于哮喘组（Ｐ＜００１），但高于正常组（Ｐ＜００１）；Ｒｒｓ（呼吸阻力）明显高于正常组（Ｐ＜００１），但明显低于哮喘组（Ｐ＜００５）。ＣＡＶ组和哮喘组间Ｄｍｉｎ（气道反应阈值）和ＳＧｒｓ（单位时间内诱导控制值之差）均无显著差异（Ｐ＞００５）。气道反应性测定及肺功能检查ＣＶＡ有较高临床价值     

老年哮喘患者呼吸驱动和气道阻力的研究

目的探讨老年哮喘患者和老年正常对照者两组人群的最大口腔吸气压(PIMAX)、最大口腔呼气压(PEMAX)、中枢呼吸驱动(P0.1)、最大通气时的中枢呼吸驱动(P0.1MAX)、中枢呼吸驱动储备(P0.1/P0.1MAX)、每分通气量(MV)校正中枢呼吸驱动(P0.1/MV)、PIMAX校正中枢呼吸驱动(P0.1/PIMAX)、有效吸气阻抗(P0.1/MIF)、吸气时间/总呼吸时间(TIN/TTOT)(也称吸气时间分数)、MV、呼吸频率(BF)、平均吸气流速(MIF)、潮气量(VT)以及4Hz振荡频率下呼吸阻力(Rfo4Hz)的水平;并同时探讨上述呼吸驱动诸项指标与4Hz振荡频率下呼吸阻力的关系。方法本研究纳入哮喘组118例、正常对照组120例,均为男性,年龄60~80岁,使用SPSS10.0forWindows对各项参数加以分析。两组之间各指标比较采用t检验,两因素之间的相关性分析采用直线相关分析。结果哮喘患者的PIMAX和PEMAX均明显低于正常人,P0.1、P0.1/MV、P0.1/PIMAX、P0.1/MIF、P0.1/P0.1MAX均明显高于正常人;Rfo4Hz与PIMAX、P0.1及其校正指标、P0.1/P0.1MAX和P0.1/MIF均明显相关。结论中枢呼吸驱动与气道阻力的测量对于老年哮喘患者的病情与预后有较确切的评价效果,可以有效地应用于临床。常规使用具有支气管扩张功能的药物可改善气道阻力,从而改善中枢呼吸驱动诸项指标,最终改善哮喘患者的病情与预后。     

不同控制水平的支气管哮喘患者气道炎症与外周气道功能状态的研究

目的 了解不同临床控制水平的支气管哮喘(简称哮喘)患者的气道炎症状况及外周气道功能,观察哮喘患者诱导痰中的炎症指标能否反映外周气道功能的改变.方法 收集在北京朝阳医院就诊的哮喘患者66例,分为控制组(21例)、部分控制组(28例)、未控制组(17例)以及健康对照组(20名).所有受试者第1天进行哮喘控制测试(ACT)评分,行脉冲振荡肺功能检测气道阻力及肺功能基础值、诱导痰细胞计数和分类以及嗜酸粒细胞阳离子蛋白(ECP)浓度测定;第2天测定呼出气一氧化氮浓度(FE_(NO)),若所测得的FEV_1≥70%预测值则行乙酰甲胆碱激发试验,当气道阻力升高至基础阻力2倍或乙酰甲胆碱达到最大浓度时终止试验,3 min后行气道阻力及通气功能检测;然后嘱受试者行5次深吸气后再复测气道阻力及通气功能.比较4组受试者诱导痰细胞计数和分类、诱导痰中ECP浓度、FE_(NO)水平与ACT评分间的相关性;观察激发后以及深吸气后外周气道阻力的变化与ACT评分、诱导痰中嗜酸粒细胞(EOS)计数、痰ECP水平及FE_(NO)间的关系.结果 (1)哮喘患者诱导痰EOS计数、ECP浓度以及FE_(NO)随着控制水平的下降逐渐增高,且诱导痰EOS计数、ECP浓度均与ACT评分呈负相关(r值分别为-0.43和-0.56,均P<0.01).(2)在健康对照组,乙酰甲胆碱激发后中心气道阻力(R_(20))、外周气道阻力(R_5-R_(20))增高程度间比较差异无统计学意义(F=3.472,P>0.05),而在控制组及部分控制组激发试验后外周气道的反应强于中心气道(F值分别为18.09和14.14,均P<0.01),但激发后R_5-R_(20)的变化与ACT评分、诱导痰EOS计数、ECP、FE_(NO)水平间无相关性.(3)深吸气后,健康对照组R_5-R_(20)由(0.13±0.14)kPa·L~(-1)·s~(-1)降至(0.08±0.09)kPa·L~(-1)·s~(-1)(t=2.84,P<0.05),而控制组、部分控制组R_5-R_(20)分别由(0.24±0.15)、(0.31±0.18)kPa·L~(-1)·s~(-1)>增至(0.30±0.16)、(0.39±0.17)kPa·L~(-1)·s~(-1)(t值分别为3.90、4.68,均P<0.01),但相关分析显示,深吸气后R_5-R_(20)的变化与ACT评分、诱导痰EOS计数、ECP、FE_(NO)水平无相关性.结论 即使在控制水平的哮喘患者,仍存在气道嗜酸粒细胞炎症,且该炎症状态随着疾病控制水平的降低而逐渐加重;哮喘患者深吸气所致的外周气道舒张作用消失;检测诱导痰中的炎症指标并不能反映外周气道功能的改变.     

Lung deposition and extremely slow inhalations of particles. Limited effect of induced airway obstruction.

Studies of lung deposition and clearance have focused on the large airways. Still, lung diseases affect also the small airways. We have developed a method for selective particle deposition in the smallest ciliated airways. Eight healthy subject inhaled 6-micron radiolabelled test particles on 3 occasions at 0.05 L/s and retention was measured for 72 hours. At one occasion, the subjects inhaled the particles at a normal airway resistance. At a second occasion, a 2-3-fold increase in airway resistance was induced by a cholinergic provocation before inhalation of the particles. At a third occasion, a corresponding provocation was induced after inhalation of the particles. The percentage lung depositions were 76 +/- 7, 68 +/- 7, and 73 +/- 8 (mean +/- SD) for "normal airway resistance," "provocation before," and "provocation after" exposures, respectively. The lower value for the "provocation before" exposure was probably a result of increased mucociliary clearance, due to cholinergic stimulation, before the first measurements of radioactivity. The retentions at 24 hours were 51 +/- 7, 52 +/- 9, and 51 +/- 8 in percent of initial lung deposition for "normal airway resistance," "provocation before," and "provocation after" exposures, respectively. We conclude that our inhalation technique is useful in studying conditions in the bronchioles, as deposition is rather independent of airway resistance.     

一磷酸腺苷支气管激发试验的建立

目的 建立一磷酸腺苷(AMP)支气管激发试验的测定方法.方法 由低浓度至高浓度倍增剂量吸入AMP试剂,在吸药前及每次吸药后进行肺功能测定,以PD_(20)FEV_1-AMP<40 mg为判断阳性阈值.对24例健康志愿者(对照组),41例支气管哮喘患者(哮喘组)分别进行AMP支气管激发试验.分析两组的阳性率、PD_(20)FEV_1-AMP、敏感性、特异性、准确度及不良反应.结果 对照组AMP激发试验均为阴性,PD_(20)FEW_1-AMP均>40 mg;哮喘组中38例阳性,阳性率为92.7%,PD_(20)FEV_1-AMP为1.25 mg(6.98 mg).哮喘组的PD_(20)FEV_1-AMP和肺功能变化值△FEV_1、△FVC、APDF的相关系数分别为-0.619(P<0.01)、-0.447(P=0.003)、-0.352(P=0.024).AMP支气管激发试验的灵敏度、特异度和准确度分别为93%、100%和95%,出现喘息、气促、咳嗽和胸闷的哮喘患者分别有78%、29%、29%和10%,但程度较轻,无严重不良反应发生.结论 AMP支气管激发试验的敏感度、特异度、准确度高,可以作为有效诊断哮喘的辅助检查方法,且其安全性良好,本研究成功建立了AMP支气管激发试验的方法.     

Upper airway response during bronchoprovocation and asthma attack

We measured laryngeal resistance (Rla), upper airway resistance (Ruaw), and lower respiratory resistance below the larynx (Rlrs) during methacholine and histamine provocation in 10 normal and 12 asthmatic subjects. In another 10 asthmatic subjects, Rla was measured during medication for spontaneous asthma attack. The Rla was measured with the low-frequency sound method (see reference 9). Direct measurements of Ruaw and Rlrs were obtained using the 3-Hz forced oscillation technique with a needle inserted below the cricoid cartilage. In normal subjects, Ruaw increased in proportion to the increase in Rlrs during methacholine and histamine provocation. In asthmatic subjects, control Ruaw was higher than the control Ruaw in normal subjects (p less than 0.001) and Ruaw did not change despite an increase in Rlrs during methacholine and histamine provocation. After medication for spontaneous asthma attack, Rla decreased in proportion to the decrease in total respiratory resistance (Rrs). We conclude that in asthmatic subjects, Rla contributes to an increase in Rrs during both the nonspasmodic period and the spontaneous asthma attack but does not do so during bronchoprovocation, probably because the larynx is less sensitive than the lower respiratory tract.     

Exercise provocation test in the diagnosis of bronchial asthma and detection of airway responsiveness]

Exercise provocation test was performed on a bicycle ergometer in 110 asthmatics, 15 allergic rhinitis patients, 10 patients with moderate chronic bronchitis and 22 healthy subjects. 87.5% (21/24) of atypical asthmatics revealed positive exercise induced asthma (EIA), with the overall positive rate of asthmatics being 90% (99/110). There was a close negative linear correlation between the maximal reduction rate in FEV1 induced by exercise (delta FEV1%) and the inhaled histamine dose needed to reduce FEV1 by 20% (PD20FEV1) (r = -0.59, P less than 0.01). None of the healthy subjects, one of 15 allergic rhinitis patients and one of 10 patients with moderate chronic bronchitis showed positive response to exercise test. In contrast, seven of 18 allergic rhinitis patients and all nine patients with moderate chronic bronchitis had positive response to histamine bronchial provocation test. Therefore, exercise provocation test is a reliable method for diagnosing EIA and detecting airway responsiveness and it may possess higher specificity than histamine provocation test in diagnosing bronchial asthma, particularly in atypical bronchial asthma.     

支气管激发试验联合血清IgE检测对咳嗽变异型哮喘的诊断价值

目的：探讨支气管激发试验联合激发前后血清ＴＩｇＥ检测对咳嗽变异型哮喘（ＣＶＡ）诊断的特异性和敏感性。方法将咳嗽变异型哮喘与急性支气管炎和无支气管疾病的患者进行比较,分别进行检测ＦＥＶ１／ＦＶＣ、支气管激发试验,以化学发光法分别检测每例患者支气管激发试验前后的ＴＩｇＥ水平,结果ＣＶＡ组气道高反应性的阳性率为９６．７％,显著高于急性支气管炎组和对照缄。ＣＶＡ患者激发前和激发后的ＴＩｇＥ水平分别为（１５     

Cold air as a bronchial provocation technique. Reproducibility and comparison with histamine and methacholine inhalation

Bronchial provocation testing with cold air was carried out on 36 asthmatic and 13 normal subjects in order to assess the reproducibility and clinical relevance of the technique as a test of airways reactivity. Sixteen subjects underwent repeat testing after an interval of two to three weeks. Using a least squares linear regression analysis, the technique was highly reproducible, with a correlation of r = 0.93 (p less than 0.001). The 21 asthmatic subjects who had exercise-provoked symptoms required a significantly lower level of ventilation of cold air to produce a 35 percent drop in specific airways conductance (PD35) than did those who had no exercise-induced asthma (33.9 L min-1 vs 45.8 L min-1; p less than 0.02). Subjects requiring no regular treatment for their asthma had a geometric mean PD35 of 62.6 L min-1, significantly higher than those requiring inhaled therapy (44.9 L min-1; p less than 0.005). Subjects requiring oral in addition to inhaled treatment had the lowest PD35 (23.6 L min-1; p less than 0.02). Atopic status did not appear to influence the response. There was a strong correlation between the PD35 to cold air and to histamine (r = 0.92; p less than 0.001) and between the PD35 to cold air and to methacholine (r = 0.86; p less than 0.001). The three techniques of assessing bronchial reactivity were equally successful in separating the normal and asthmatic groups. The results indicate that cold air provocation may be reliably and reproducibly used to assess bronchial reactivity. The use of a naturally-occurring stimulus of asthma in all subjects has great potential as an investigational technique.     

Airway hyperresponsiveness: the usefulness of airway hyperresponsiveness testing in epidemiology,in diagnosing asthma and in the assessment of asthma severity

The present PhD thesis was conducted at the Respiratory Research Unit at the Pulmonary Department L in Bispebjerg Hospital, Copenhagen, Denmark and describes airway hyperresponsiveness in asthma patients in four studies. The first study concerned risk factors for the development of asthma in young adults in a 12‐year prospective follow‐up study of a random population sample of 291 children and adolescents from Copenhagen, who were followed up from the age of 7–17 years (1986) until the age of 19–29 years (1998). During follow‐up, 16.1% developed asthma, and in these subjects, the most important predictor of asthma development was airway hyperresponsiveness to histamine at baseline. Airway hyperresponsiveness is associated with more severe asthma and a poorer prognosis in terms of more exacerbations and less chance of remission of the disease. The second study described the relation between airway hyper‐responsiveness to methacholine and the quality of life in 691 asthma patients: In asthma patients with airway hyperresponsiveness to methacholine, the quality of life measured with a validated questionnaire (Junipers Asthma Quality of Life Questionnaire) was significantly reduced compared to asthma patients who did not respond to bronchial provocation with methacholine. Airway hyperresponsiveness is not uncommonly observed in non‐asthmatics, and the response to bronchial provocation with methacholine is therefore relatively non‐specific. The mannitol test is a relatively new bronchial provocation test that acts indirectly on the smooth airway muscle cells through the release of mediators from inflammatory cells in the airways; the mannitol could consequently be a more specific test compared with methacholine. The third study showed that out of 16 non‐asthmatics with airway hyperresponsiveness to methacholine, 15 did not respond to bronchial provocation with mannitol Because of the mechanism of action of mannitol, it seems plausible that the response to mannitol is more closely correlated to airway inflammation in asthma compared with the response to methacholine. The fourth study showed that in 53 adult asthma patients, who did not receive treatment with inhaled steroids, there was a positive correlation between the degree of airway inflammation and the degree of airway responsiveness to mannitol as well as to methacholine. The mannitol does, however, have the advantage of being a faster and simpler test to perform, requiring no additional equipment apart from a spirometer. Conclusions: Airway hyperresponsiveness in children and in adolescents without asthma predicts asthma development in adulthood. Asthma patients with airway hyperresponsiveness to methacholine have a poorer quality of life as well as more severe disease and a poorer prognosis compared with asthma patients without airway hyperresponsiveness. Bronchial provocation with mannitol as well as with methacholine were useful for evaluating the severity of asthma and the degree of airway inflammation, and accordingly for determining the need for steroid statement. The mannitol test does, however, have practical advantages over the methacholine test that make it preferable for clinical use.     

Bronchial Reactivity. Its Measurement and Clinical Significance**

Summary: Bronchial reactivity was measured in 19 normal and 21 asthmatic subjects as the percentage fall in FEV_1,0 after a graded dose of inhaled methacholine. The mean fall was 6 per cent in normal and 44 per cent in asthmatic subjects. It is suggested that a simple and specific test for asthma, based on this response, has a definite place in the routine pulmonary function laboratory. This test can be clinically useful in establishing or excluding the presence of bronchial asthma in cases where the diagnosis may be otherwise uncertain.