Exercise-induced asthma and the use of hypertonic saline aerosol as a bronchial challenge.
Exercise-induced asthma and the use of hypertonic saline aerosol as a bronchial challenge.
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DOI：
10.1111/j.1440-1843.1996.tb00029.x
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发表时间：
1996-09-01
期刊：
影响因子：
--
通讯作者：
Anderson, S D
中科院分区：
文献类型：
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作者：
Anderson, S D
运动性哮喘是一种常见的疾病，其患病率似乎在全球范围内呈上升趋势。环境影响评价的研究曾经局限于大学教学医院的研究领域，现已扩展到学校操场、国防设施和体育机构。为了在实验室和现场研究环境影响评价，已经制定了标准化的方案。使用常压或等压干燥空气过度通风的替代挑战正变得流行起来，因为它比锻炼更有优势，至少对成年人来说是这样。导致呼吸道狭窄的刺激是在过度换气和锻炼期间吸入干燥空气造成的，在此期间，为了调节吸入的空气，水分从呼吸道蒸发。呼吸道狭窄的机制被认为是由于水分丢失的脱水效应，特别是与其可能导致呼吸道变得高渗透压有关。肥大细胞介质如组胺和亮三烯可能参与了EIA，因为特定的拮抗剂可以减轻病情。根据EIA的渗透理论，研究确定EIA受试者是否对吸入高渗氯化钠气雾剂引起的呼吸道渗透压升高的影响敏感。使用由超声波雾化器产生的4.5%氯化钠气雾剂的挑战方案已用于识别哮喘患者并评估药物治疗的反应。运动、过度换气和高渗盐水的生理生化反应和药物反应有许多相似之处。用高渗盐水挑战更容易、更便宜，因为不需要昂贵的设备和干燥的空气来源，就像锻炼或过度换气一样。获得剂量-反应曲线而不是单一反应的能力，以及同时收集炎症细胞的能力，使高渗盐水挑战成为研究疑似哮喘患者的一种有吸引力的技术。
Exercise induced asthma is a common complaint and the prevalence appears to be increasing worldwide. Once confined to the research domain of university teaching hospitals, the study of EIA has extended into the school playground, defence force establishments and sports institutions. Standardized protocols have been developed to study EIA in the laboratory and in the field. A surrogate challenge using eucapnic or isocapnic hyperventilation with dry air is becoming popular because it has advantages over exercise, at least for adults. The stimulus that leads the airways to narrow is caused by the inhalation of dry air during hyperventilation and exercise, during which water is evaporated from the airways in order to condition the inspired air. The mechanism whereby the airways narrow is thought to be due to the dehydrating effects of water loss, particularly in relation to its potential to cause the airways to become hyperosmolar. Mast cell mediators such as histamine and the leucotrienes are probably involved in EIA because specific antagonists reduce severity. As a result of the osmotic theory of EIA, studies were carried out to determine whether subjects with EIA were sensitive to the effects of increasing airway osmolarity by inhalation of hyperosmolar aerosols of sodium chloride. A challenge protocol using an aerosol of 4.5% sodium chloride, generated from an ultrasonic nebulizer, has been used to identify persons with asthma and to assess response to drug therapy. There are many similarities between responses to exercise, hyperventilation and hypertonic saline in the physiological and biochemical responses and the responses to drugs. Challenge with hypertonic saline is easier and cheaper to use because expensive equipment and a source of dry air is not required as with exercise or hyperventilation. The ability to obtain a dose-response curve rather than a single response and the ability to collect inflammatory cells at the same time make challenge with hypertonic saline an attractive technique to study patients suspected of having asthma.