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Bronchial hyperreactivity in cystic fibrosis and asthma
ALLEROY VOLUME
ABSTRACTS NUMBER
57
3
March, 1979 From
the Allergy
Division
oj
The Jewish Hospital and Medical Center of Brooklyn
Editor-in-Chief MURRAY M. ALBERTBrooklyn, N. I’.
Editorial
Board
BERNARD SIEGEL Brooklyn, N. Y. HAROLD FRIEDMAN Cleveland, Ohio DAVID STEIN Spring Valley, N. Y. MONROE COLEMAN Stamford, Corm. EUGENE WALZER Bridgeport, Corm.
Asthma
and hay fever
Bronchial hyperreactivity fibrosis and asthma
in cystic
Mitchell, I., Corey, M., Woenne, R., Krastins, 1. R. B., and Levison, H.: J. Pediatr. 93:744, 1978. Patients with cystic fibrosis (CF) have an increased incidence of allergic rhinitis, and their first-degree relatives have a high incidence of atopic disorders. Since wheezing is a major clinical symptom of CF and tests useful in distinguishing asthma give variable results in patients with this disease, it may be difficult to determine when asthma coexists with CF. This study was thus undertaken to evaluate the bronchial reactivity to methacholine and histamine challenge in children with these disorders. The study group was comprised of 113 patients with CF (7 to 37 yr), 50 patients with asthma (7 to 18 yr), and 26 healthy controls (7 to 18 yr). Patients were randomly selected and those with clinical evidence of viral or bacterial infection in the 4 wk prior to the study were excluded. Bronchodilators, sodium cromoglycate, and antihistamines were not administered in the 12 to 24 hr preceding the bronchial challenge. Eighty-one patients with CF were skin-tested by scratch and intradermal techniques to a variety of inhalant allergens. FEV, (forced expiratory volume in 1 set) and MMEF (maximum midexpiratory flow) were determined in all patients and thoracic gas volume and airways resistance were measured in approximately 507~ before and after challenges with varying concentrations of methacholine and histamine. The methacholine challenge was positive in 51% of the patients with CF and in 98% of those with asthma. The CF responders (those patients with a fall of 20% or greater in
Associate
Editors
SHELDON BERGER Freehold, N. J. NEIL GOLDMAN Ossining, N. Y. MANDAKOLATHUR R. MURAL1 Brooklyn, N. Y
Consultant
Editor
MATTHEW WALZER Brooklyn, N. Y.
FEV,) had a significantly (p < 0.001) poorer baseline pulmonary function than the nonresponders. Whereas 80% were responders in those subjects whose baseline FEV, was 40% or less of predicted, only 40% were responders in those whose baseline FEV, was 80% or more of predicted. A significantly higher incidence of wheezing (p < 0.001) and infantile eczema (p < 0.025) was present among the responders than among the nonresponders, but the incidence of hay fever, nasal polyps, and respiratory illness during the first year was similar in both groups. Dose response curves differed in the asthmatic and CF patients. The PD,, (provocative dose necessary to produce a 12% fall in FEV,) in asthmatic patients was significantly (p < 0.001) less than in those with CF, and the rate of fall of FEV, was steeper. The mean FEVl at the conclusion of the study was lower in the asthmatic than in the CF patients, but was similar 1.5min later. Both asthmatic and CF patients demonstrated a significant rise in FEV, after the inhalation of salbutamol, but the mean rise in the asthmatic patients was beyond the baseline values. Positive skin tests were demonstrated in 80 of 81 patients with CF. Both the mean number of positive skin test reactions and the incidence of atopic disorders in first-degree relatives were similar in responders and nonresponders. Seven of 33 patients (21%) with CF had a positive challenge with histamine. Whereas all patients positive with histamine were also positive with methocholine, 7 patients were positive with methocholine and negative with histamine. We conclude that bronchial hyperreactivity in CF is common but differs from that observed in asthma. We suggest that not all patients with CF will necessarily benefit from those drugs used in the treatment of asthma. S. B.
9
ABSTRACTS NUMBER
57
3
March, 1979 From
the Allergy
Division
oj
The Jewish Hospital and Medical Center of Brooklyn
Editor-in-Chief MURRAY M. ALBERTBrooklyn, N. I’.
Editorial
Board
BERNARD SIEGEL Brooklyn, N. Y. HAROLD FRIEDMAN Cleveland, Ohio DAVID STEIN Spring Valley, N. Y. MONROE COLEMAN Stamford, Corm. EUGENE WALZER Bridgeport, Corm.
Asthma
and hay fever
Bronchial hyperreactivity fibrosis and asthma
in cystic
Mitchell, I., Corey, M., Woenne, R., Krastins, 1. R. B., and Levison, H.: J. Pediatr. 93:744, 1978. Patients with cystic fibrosis (CF) have an increased incidence of allergic rhinitis, and their first-degree relatives have a high incidence of atopic disorders. Since wheezing is a major clinical symptom of CF and tests useful in distinguishing asthma give variable results in patients with this disease, it may be difficult to determine when asthma coexists with CF. This study was thus undertaken to evaluate the bronchial reactivity to methacholine and histamine challenge in children with these disorders. The study group was comprised of 113 patients with CF (7 to 37 yr), 50 patients with asthma (7 to 18 yr), and 26 healthy controls (7 to 18 yr). Patients were randomly selected and those with clinical evidence of viral or bacterial infection in the 4 wk prior to the study were excluded. Bronchodilators, sodium cromoglycate, and antihistamines were not administered in the 12 to 24 hr preceding the bronchial challenge. Eighty-one patients with CF were skin-tested by scratch and intradermal techniques to a variety of inhalant allergens. FEV, (forced expiratory volume in 1 set) and MMEF (maximum midexpiratory flow) were determined in all patients and thoracic gas volume and airways resistance were measured in approximately 507~ before and after challenges with varying concentrations of methacholine and histamine. The methacholine challenge was positive in 51% of the patients with CF and in 98% of those with asthma. The CF responders (those patients with a fall of 20% or greater in
Associate
Editors
SHELDON BERGER Freehold, N. J. NEIL GOLDMAN Ossining, N. Y. MANDAKOLATHUR R. MURAL1 Brooklyn, N. Y
Consultant
Editor
MATTHEW WALZER Brooklyn, N. Y.
FEV,) had a significantly (p < 0.001) poorer baseline pulmonary function than the nonresponders. Whereas 80% were responders in those subjects whose baseline FEV, was 40% or less of predicted, only 40% were responders in those whose baseline FEV, was 80% or more of predicted. A significantly higher incidence of wheezing (p < 0.001) and infantile eczema (p < 0.025) was present among the responders than among the nonresponders, but the incidence of hay fever, nasal polyps, and respiratory illness during the first year was similar in both groups. Dose response curves differed in the asthmatic and CF patients. The PD,, (provocative dose necessary to produce a 12% fall in FEV,) in asthmatic patients was significantly (p < 0.001) less than in those with CF, and the rate of fall of FEV, was steeper. The mean FEVl at the conclusion of the study was lower in the asthmatic than in the CF patients, but was similar 1.5min later. Both asthmatic and CF patients demonstrated a significant rise in FEV, after the inhalation of salbutamol, but the mean rise in the asthmatic patients was beyond the baseline values. Positive skin tests were demonstrated in 80 of 81 patients with CF. Both the mean number of positive skin test reactions and the incidence of atopic disorders in first-degree relatives were similar in responders and nonresponders. Seven of 33 patients (21%) with CF had a positive challenge with histamine. Whereas all patients positive with histamine were also positive with methocholine, 7 patients were positive with methocholine and negative with histamine. We conclude that bronchial hyperreactivity in CF is common but differs from that observed in asthma. We suggest that not all patients with CF will necessarily benefit from those drugs used in the treatment of asthma. S. B.
9