Analysis of factors associated with bronchial hyperreactivity to methacholine in bronchiectasis
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Nonspecific bronchial hyperreactivity (BHR) has been reported to occur in patients with bronchiectasis. To evaluate this further, we studied 77 patients with stable bronchiectasis (noncystic fibrosis) with special reference to the prevalence of BHR to methacholine (MCh), and its relation to lung function, sputum characteristics, concommitant asthma, and atopy. The concentration of MCh required to produce a fall of 20% in forced expiratory volume in 1 s (FEV1), PC20, was determined by Wright’s nebulization tidal breathing method. BHR defined by a PC20 ≤ 8 mg/ml was found in 21 of 47 (45%) subjects who underwent bronchial challenge. Presence of BHR was positively associated with low baseline spirometric values, diagnosis of asthma, long duration of disease, and elevated total IgE on univariant analysis, and was significantly related to FEV1/forced vital capacity (FVC) ratio and asthma on multiple regression analysis. Ten of the 21 hyperreactive subjects did not have clinical asthma, whereas all 11 of 22 subjects with clinical asthma who underwent bronchial challenge were hyperreactive. Among those with BHR, there was a positive correlation between PC20 and baseline FEV1. When patients were further classified into asthmatic and nonasthmatic subjects, a positive correlation between PC20 and FEV1 was seen only in those without asthma. Frequency of infective episodes and inflammatory score of sputum assessed by average daily volume, purulence, and leukocyte count did not differ significantly in the groups with and without BHR. These results suggest that BHR in patients with bronchiectasis is associated with coexistent asthma and worse spriometric values, and not with the severity of bronchial sepsis.
Key wordsBronchial reactivity Methacholine Bronchiectasis
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- 1.American Thoracic Society (1962) Definitions and classification of chronic bronchitis, asthma and pulmonary emphysema. Am Rev Respir Dis 85:762–768Google Scholar
- 8.Cole PJ (1984) A new look at the pathogenesis and management of persistent bronchial sepsis: a ‘vicious circle’ hypothesis and its logical therapeutic consequences. In: Davies RJ (ed) Strategies for the management of chronic bronchial sepsis. Medicine Publishing Foundation, Oxford, pp 1–20Google Scholar
- 15.Kelly CA, Stenton C, Gould K, Hendrick DJ, Walters EH (1987) The effect of high dose amoxycillin on bronchial responsivenesess and symptoms in patients with bronchiectasis. Am Rev Respir Dis 132:A269Google Scholar
- 18.Norn S, Stahl Skov P, Jensen C, Bog-Hansen TC, Koch C, Permin H et al (1987) Lectin-mediated reactions: a new mechanism in bronchial hyperresponsiveness. In: Nadel JA, Pauwels R, Snashall PD (eds) Bronchial hyperresponsiveness: normal and abnormal control, assessment and therapy. Blackwell Scientific Publications, Oxford pp 331–336Google Scholar
- 21.Ramsdale EH, Hargreave FE (1986) Airway hyperresponsiveness. In: Flenley DC, Petty TL (eds) Recent advances in respiratory medicine, 4. Churchill Livingstone, Edinburgh, pp 13–24Google Scholar
- 26.Reid LM (1986) The pathology of obstructive and inflammatory airway diseases. Eur J Respir Dis 147 (Supp):26–37Google Scholar
- 30.Thurlbeck WM (1976) Chronic airflow obstruction in lung disease. WB Saunders, PhiladelphiaGoogle Scholar