Airway resistance at maximum inhalation as a marker of asthma and airway hyperresponsiveness.
Airway resistance at maximum inhalation as a marker of asthma and airway hyperresponsiveness.
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DOI：
10.1186/1465-9921-12-96
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发表时间：
2011-07-15
影响因子：
5.8
通讯作者：
Lutchen KR
中科院分区：
文献类型：
--
作者：
Mendonça NT;Kenyon J;LaPrad AS;Syeda SN;O'Connor GT;Lutchen KR
哮喘患者在最大吸气时气道扩张减弱，可能是由于气道壁的结构差异和/或气道平滑肌的功能差异，这些因素也可能增加气道对支气管收缩刺激的反应性。本研究的目的是验证气道高反应性受试者在最大吸气时可达到的最小气道阻力（Rmin）异常升高的假设。在34名非哮喘和35名哮喘受试者中使用8 Hz的强制振荡测量Rmin。分别测定支气管扩张（沙丁胺醇）和支气管收缩（甲胆碱）前后的Rmin和肺活量指标。通过对84名健康受试者的初步研究，首次建立了基线Rmin值与身高的相关性。哮喘患者的基线Rmin %预测高于非哮喘患者（134±33比109±19%预测，p = 0.0004）。使用受试者工作特征曲线进行的敏感性-特异性分析表明，基线Rmin能够比大多数肺活量测定指标更好地识别气道高反应性（PC20 < 16 mg/mL）受试者（预测Rmin %、预测FEV1 %和预测fef25 - 75%的曲线下面积分别为0.85、0.78和0.87）。此外，基线Rmin < 100%预测的受试者中有80%没有气道高反应性，而基线Rmin < 100%预测的受试者中有100%有气道高反应性，无论临床分类是哮喘还是非哮喘。这些发现表明，基线Rmin，一种比肺活量测定法更容易执行的测量方法，在区分气道高反应性和非高反应性受试者方面的表现与标准肺活量测定指标一样好，甚至更好。基线Rmin与哮喘和气道高反应性的关系可能反映了气道壁硬化和高反应性之间的因果关系。结合症状史，Rmin可以为评估哮喘和监测治疗反应提供临床有用的工具。
Asthmatics exhibit reduced airway dilation at maximal inspiration, likely due to structural differences in airway walls and/or functional differences in airway smooth muscle, factors that may also increase airway responsiveness to bronchoconstricting stimuli. The goal of this study was to test the hypothesis that the minimal airway resistance achievable during a maximal inspiration (Rmin) is abnormally elevated in subjects with airway hyperresponsiveness. The Rmin was measured in 34 nonasthmatic and 35 asthmatic subjects using forced oscillations at 8 Hz. Rmin and spirometric indices were measured before and after bronchodilation (albuterol) and bronchoconstriction (methacholine). A preliminary study of 84 healthy subjects first established height dependence of baseline Rmin values. Asthmatics had a higher baseline Rmin % predicted than nonasthmatic subjects (134 ± 33 vs. 109 ± 19 % predicted, p = 0.0004). Sensitivity-specificity analysis using receiver operating characteristic curves indicated that baseline Rmin was able to identify subjects with airway hyperresponsiveness (PC20 < 16 mg/mL) better than most spirometric indices (Area under curve = 0.85, 0.78, and 0.87 for Rmin % predicted, FEV1 % predicted, and FEF25-75 % predicted, respectively). Also, 80% of the subjects with baseline Rmin < 100% predicted did not have airway hyperresponsiveness while 100% of subjects with Rmin > 145% predicted had hyperresponsive airways, regardless of clinical classification as asthmatic or nonasthmatic. These findings suggest that baseline Rmin, a measurement that is easier to perform than spirometry, performs as well as or better than standard spirometric indices in distinguishing subjects with airway hyperresponsiveness from those without hyperresponsive airways. The relationship of baseline Rmin to asthma and airway hyperresponsiveness likely reflects a causal relation between conditions that stiffen airway walls and hyperresponsiveness. In conjunction with symptom history, Rmin could provide a clinically useful tool for assessing asthma and monitoring response to treatment.
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影响因子：
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作者：
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通讯作者：
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作者：
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作者：
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作者：
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DOI：
10.1164/rccm.200609-1317oc
发表时间：
2007-07-15
影响因子：
24.7
作者：
Brown, Nathan.;Salome, Cheryl M.;King, Gregory G.
通讯作者：
King, Gregory G.