Assessment of changes in 1-second forced expiratory volume in bronchial provocation testing.
Assessment of changes in 1-second forced expiratory volume in bronchial provocation testing.
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评估支气管激发试验中 1 秒用力呼气量的变化。
DOI：
10.1002/ppul.1950060203
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发表时间：
1989
影响因子：
3.1
通讯作者：
Wall,M
中科院分区：
文献类型：
--
作者：
Wall,M
吸入增加剂量的抗原、乙酰甲胆碱或组胺至1秒用力呼气量（FEV 1）降低基线的固定百分比（通常为20%），已成为评估患者是否存在支气管高反应性的常用方法。在本期和前几期《儿科肺病学》上发表的文章中，预先确定的反应百分比已用于评估患有囊性纤维化和哮喘等疾病的儿童支气管高反应性的机制。在这篇评论中，我将回顾一些有关隔离区的历史背景，以及支持和反对使用隔离区的论点。对于儿科肺病学家来说，理解这些争论似乎特别重要，因为我们现在已经开发了许多年的婴儿肺功能测试，并且一些似乎有希望作为评估年轻不合作受试者支气管高反应性的方法。吸入激发用于确定是否有任何个体具有与医生-确诊为典型哮喘大多数研究者和临床医生将FEV 1降低20%作为哮喘样反应的截止值的确切原因尚不完全清楚。经常被引用的一个原因是，这种变化超过了FEV 1的平均受试者内、测试期内变异系数（标准差平均值× 100）3或4倍，因此这种变化不太可能单独偶然发生。在本期杂志中，货车Aalderen等人发现他们的哮喘儿童的受试者内变异系数为3.3%。因此，毫不奇怪，他们发现FEV 1降低10%，这将超过受试者内变异系数3的倍数，在检测支气管高反应性方面与PD 15或PDZO一样敏感。以类似的方式，其他人已经发现PD 10或PD 15在从正常受试者中分离出典型哮喘患者方面与PD 2一样敏感。使用PD 20的另一个理由是临床相关性。例如，在哮喘患者中已经显示，引起FEV 1下降20%所需的组胺浓度与药物治疗和临床状态的要求之间存在良好的相关性。2，3在对个体进行支气管激发时，在任何水平上使用设定的截止点的主要问题如下：
Inhalation of increasing doses of antigen, methacholine, or histamine to the point where l-second forced expiratory volume (FEV1) decreases by a fixed percentage of baseline, usually 20%, has become a popular method of assessing patients for the presence of bronchial hyperreactivity. In articles published in this and many previous issues of Pediatric Pulmonology a predetermined percent response has been used to assess mechanisms of bronchial hyperreactivity in children with diseases such as cystic fibrosis and asthma. In this commentary I will review some of the historical background to the PDZO and arguments for and against its use. It seems especially important for pediatric pulmonologists to understand these arguments since we are now a number of years into the development of lung function tests for infants, and some appear to have promise as methods of assessing bronchial hyperreactivity in young, uncooperative subjects.As originally conceived, inhalation challenges were to be used to determine whether any individual had response characteristics similar to those of patients with physician-diagnosed classical asthma. The exact reasons why most investigators and clinicians have settled upon a 20% decrease in FEVl as being the cut-off for an asthma-like response are not entirely clear. One reason that is frequently cited is that such a change exceeds the average within-subject, within-test-session coefficient of variation (standard deviatiodmean X 100) for FEVl by a multiple of 3 or 4, and thus such a change is unlikely to occur by chance alone. In the current issue of this journal van Aalderen et al. found that the within-subject coefficient of variation for their asthmatic children was 3.3%.'Thus, it is not surprising that they found that a 10% decrease in FEVl, which would exceed the intrasubject coefficient of variation by a multiple of 3, was just as sensitive as a PD15 or PDZO in detecting bronchial hyperreactivity. In a similar fashion others have found that PDlo or PD15 are just as sensitive as the PD2,-, in separating out classical asthmatics from normal subjects. Another rationale for the use of PD20 has been clinical relevance. For instance, it has been shown in asthmatics that there is a good correlation between the concentration of histamine required to cause a 20% fall in FEVl and requirements for medication and clinical status. 2, 3 The major problem with using a set cut-off point at any level in performing bronchial provocation on individuals sus-