NONSPECIFIC BRONCHIAL REACTIVITY AND ITS RELATIONSHIP TO THE CLINICAL EXPRESSION OF ASTHMA - A LONGITUDINAL-STUDY
NONSPECIFIC BRONCHIAL REACTIVITY AND ITS RELATIONSHIP TO THE CLINICAL EXPRESSION OF ASTHMA - A LONGITUDINAL-STUDY
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DOI：
10.1164/ajrccm/140.2.350
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发表时间：
1989-08-01
期刊：
影响因子：
--
通讯作者：
HOLGATE, ST
中科院分区：
文献类型：
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作者：
JOSEPHS, LK;GREGG, I;HOLGATE, ST
非特异性支气管反应性对哮喘日常临床表现的影响尚不确定。我们在一项对8名儿童和12名成人的纵向研究中研究了这种关系。在12至18个月的时间内，每至3周测量一次对乙酰甲胆碱的反应性，得出导致FEV 1（PD 20）下降20%的剂量。在整个研究过程中，所有患者每天记录症状和治疗情况，每天测量两次呼气峰流速（PEF）。受试者的总体反应性（中位PD 20）与晨间PEF的平均日间变化（Spearman rho =-0.53，p = 0.016）和PEF的日间变化（Spearman rho =-0.60，p = 0.004）之间存在显著相关性。然而，检查受试者内反应性和哮喘之间的时间关系，个体PD 20测量值与并发哮喘严重程度并不一致：只有6名受试者的PD 20变化通常反映了症状或PEF的同时趋势。在一些患者中，哮喘的恶化在不存在支气管高反应性（PD 20> 12.8 μ mol）的情况下发生。我们的结论是，非特异性支气管反应性是唯一的一种机制，在哮喘气流阻塞的基础上，它的关系，哮喘的临床状态是不够接近的实际临床应用。
The contribution of nonspecific bronchial reactivity to the day-to-day clinical expression of asthma is uncertain. We have examined this relationship in a longitudinal study of eight children and 12 adults. Measurements of reactivity to methacholine were made every to to 3 wk over a period of 12 to 18 months, deriving the dose that caused a 20% fall in FEV1 (PD20). Throughout the study, all patients kept a daily record of symptoms and treatment and twice daily measurements of peak expiratory flow (PEF). A significant relationship was found between subjects'' overall reactivity (median PD20) and both their average day-to-day variation in morning PEF (Spearman''s rho = -0.53, p = 0.016) and diurnal variation in PEF (Spearman''s rho = -0.60, p = 0.004). However, examining the temporal relationship between reactivity and asthma within subjects, individual PD20 measurements were not consistently related to concurrent asthma severity: in only six subjects did changes in PD20 generally reflect simultaneous trends in symptoms or PEF. In several patients, exacerbations of asthma occurred in the absence of bronchial hyperreactivity (PD20 > 12.8 .mu.mol). We conclude that nonspecific bronchial reactivity is only one mechanism underlying airflow obstruction in asthma, and that its relationship to the clinical state of asthma is not sufficiently close to be of practical clinical use.