Childhood Asthma Clinical Trial
Official title:
More Relaxation by Deep Breath on Methacholine- Than on Exercise-Induced Bronchoconstriction During the Routine Testing of Asthmatic Children
Deep inhalation (DI) dilates normal airway precontracted with methacholine. The fact that this effect is diminished or absent in asthma could be explained by the presence of bronchial inflammation. The hypothesis tested was that DI induces more relaxation in methacholine induced bronchoconstriction—solely determined by the smooth muscle contraction—than in exercise induced bronchoconstriction, which is contributed to by both smooth muscle contraction and airway wall inflammation.
Children were referred to the lung function department by their pediatric pulmonologist.
Asthma was defined by a complaint of wheezing, cough, dyspnoea or chest tightness at rest or
on exercising and a positive response to methacholine or exercise challenge.
The response to exercise was considered positive when Forced Expiratory Volume in 1 s (FEV1)
decreased at least 8% from Baseline.
The response to methacholine was considered positive when FEV1 decreased at least 20% or Rrs
increased at least 50% from baseline, at or below a cumulated dose of 1,200 μg.
Bronchodilator medications were discontinued at least 12 hours prior to the testing and
provocation allowed when the child had been free of respiratory symptoms for at least 2 weeks
and baseline FEV1 was larger than 70% pred. Exercise and methacholine groups were matched for
age, height, baseline FEV1 z-score, a moderate level of airway response to challenge and DI
amplitude ranging 40-60% of the predicted Forced Vital Capacity (FVC). Written informed
consent was obtained from the children and their parents for the procedures. Procedures for
spirometry, exhaled fraction of NO (FENO), GrsDI (Respiratory conductance response to a deep
inhalation) and challenges have been described previously. Acceptable GrsDI's were analyzed
at a 10-20% FEV1 decrease from baseline. Statistics were performed using Mann-Whitney, Chi
square tests and multiple regression as required. Data are median and interquartile range.
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