No abstract available.
Asthma* ; Bronchial Hyperreactivity ; Child* ; Humans

The morphological changes of the allergic immunological lesion is difficult to realize. In 1975, Gell and Coombs classified the allergic- immunological reactions into 4 types. The type I included the anti bodies causes sensitivity for tissues by binding with the mastocytes leading to release of the mediate chemicals. The reactions occurs early and severe which damages mainly the circulation system and organs with smooth muscles. The type II causes cellular toxic and cellulicidal. The type III causes the the tissue lesions due to the toxicity of the antigen antibody complex. The type IV includes the tuberculin reaction. The pneumobronchial allergic-immunological deases according to the classification of Gell and Coombs included the type I reactions: the pneumobronchial diseases with the antigen- antibody reactions (prophylatic, asthma, respiratory allergy: type IV; hypersensityvity occurs only within 24-72 hours after exposured with the antigen, not related with the antibody but related with the cell, found most frequent in the microbial,viral and parasitological infections and the dermatological reactions due to induction with the normal chemicals
Bronchial Hyperreactivity ; Hypersensitivity ; Immune System Diseases

It is commonly accepted that airway hyperresponsiveness (AHR) is a chronic airway inflammation although the exact mechanism of its pathogenesis is still unclear. In the past ten years, an epithelial defect hypothesis has gradually gained supports from the main stream. Airway epithelium is no longer considered only as a simple mechanic barrier but an active interface between the inner and outer environment. Bronchial epithelial cells play a critical role in maintenance of homeostasis in the airway local microenvironment through a wide range of physiologic functions including anti-oxidation, exocrine/endocrine secretions, mucus production and antigen presentation under health and stressed/inflamed/injured conditions. It is reasonably hypothesized that disruption of these functional processes or defects in airway epithelium integrity may be the initial steps leading to airway hyperresponsiveness such as in asthma and chronic obstructive pulmonary disease.
Animals ; Bronchi ; cytology ; Bronchial Hyperreactivity ; physiopathology ; Epithelial Cells ; pathology ; Humans

Airway Remodeling ; Asthma ; physiopathology ; Bronchial Hyperreactivity ; etiology ; Bronchitis ; physiopathology ; Humans

OBJECTIVEAsthma is the most common chronic respiratory disease of children. The association between asthma and bronchial hyperresponsiveness (BHR) has been well-demonstrated. The objective of the study was to investigate relationship between the bronchial responsiveness and the peripheral obstruction in stable asthmatic children.

METHODSThirty-nine children with stable asthma, 28 boys and 11 girls with a mean age of 128 (77 - 197) months, received the bronchial provocation test by the maximal expiratory flow-volume (MEFV) curve measurement. The children were divided into two groups: one with maximal mid-expiratory flow (MMEF) < 80% (n = 15) and the other with MMEF >/= 80% (n = 24). Positive rates of bronchial provocation test were compared between groups of MMEF < 80% and >/= 80% and between the children whose relief duration was 12 months (n = 13). Statistical analysis was performed by using Chi-square, rank sum test or t test (SPSS10.0), P values < 0.05 were considered significant.

RESULTSIn the 39 stable asthmatic children, 15 (38%) were detected MMEF < 80% and 28 (72%) had BHR. There was no significant difference in BHR between the children with MMEF < 80% and those with MMEF >/= 80% (P > 0.05). There was no significant difference in BHR between the children whose relief duration was 12 months (P > 0.05), either.

CONCLUSIONSThe stable asthmatic children still had peripheral obstruction and BHR, which indicated the presence of airway inflammation. There was no significant difference in BHR between the children whose relief duration was 12 months.

Asthma ; physiopathology ; Bronchial Hyperreactivity ; physiopathology ; Bronchial Provocation Tests ; Child ; Female ; Humans ; Male ; Maximal Midexpiratory Flow Rate

PURPOSE: It is well-known that the bronchial challenge test is very important to evaluate the bronchial hyperresponsiveness in asthma. This study was done to find the items of clinical symptoms and signs as a predictors for bronchial hyperresponsiveness in compare with methacholine challenge test. METHODS: The methacholine challenge test and allergy questionnaire(total 90 items) were done for 76 children with suspected asthma aged 4 to 11 years old who visited children's allergy clinic from the February to the June in 1999. Methacholine was used in increasing doses from 0.125 mg/mL to 16 mg/mL to a greater-than-20%(PC20) drop in FEV1 was obtained, or to the maximum concentration of 16 mg/mL was reached. The subjects were requested to inhale each preparation for 2 minutes. The bronchial hyperreactivity was considered severe if a PC20 was reached at a concentration of 0.125 mg/mL, moderate if the PC20 was reached at between 0.25 and 0.5 mg/mL(group C), mild if the PC20 was obtained with concentrations between 2 and 8 mg/mL(group B), and negative if the PC20 was obtained with concentrations 16 mg/mL or not obtained with any of the concentrations used(group A). We compared bronchial hyperreactivity with items of the questionnaire. RESULTS: 1) Fifteen children are normal(group A), thirty-nine are mild(group B), nineteen are moderate(group C), and three are severe(group C) among 76 children. 2) Symptom score and bronchial hyperreactivity showed statistical significant correlation. 3) Items which had statistical significance(P<0.05) between the methacholine challenge test and the questionnaire are dyspneic asthma attack, more than twice of asthma attck, asthma history diagnosed by doctor, wheezing regardless of common cold, and wheezing episode for last three months. 4) Family history, residential environment, duration of cough and other allergic disease history didn't have any relation. CONCLUSION Some items of asthma questionaire had a close relationship with the severity of bronchial hyperresponsiveness by methacholine challenge test for the children with suspected asthma. We hope that those items of asthma qyestionaire be helpful to predict the airway hyperresponsiveness for childhood asthma.
Asthma* ; Bronchial Hyperreactivity ; Bronchial Provocation Tests ; Child ; Common Cold ; Cough ; Hope ; Humans ; Hypersensitivity ; Methacholine Chloride* ; Surveys and Questionnaires ; Respiratory Sounds

OBJECTIVES: Chronic rhinosinusitis (CRS) is common disease in otorhinolaryngology and will lead to lower airway abnormality. However, the only lung function in CRS patients and associated factors have not been much studied. METHODS: One hundred patients with CRS with nasal polyps (CRSwNP group), 40 patients with CRS without nasal polyps (CRSsNP group), and 100 patients without CRS were enrolled. The difference in lung function was compared. Meanwhile, CRSwNP and CRSsNP group were required to undergo a bronchial provocation or dilation test. Additionally, subjective and objective outcomes were measured by the visual analogue scale (VAS), 20-item Sino-Nasal Outcome Test (SNOT-20), Lund-Mackay score, Lund-Kennedy endoscopic score. The correlation and regression methods were used to analyze the relationship between their lung function and the above parameters. RESULTS: The forced expiratory volume in 1 second (FEV1) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) of CRSwNP group were significantly lower than other groups (P<0.05). On peak expiratory flow, there was no difference between three groups. In CRSwNP group, FEV1 was negatively correlated with peripheral blood eosinophil count (PBEC) and duration of disease (r=–0.348, P=0.013 and r=–0.344, P=0.014, respectively), FEF25-75 negatively with VAS, SNOT-20 (r=–0.490, P=0.028 and r=–0.478, P=0.033, respectively) in CRSsNP group. The incidence of positive bronchial provocation and dilation test was lower in CRSwNP group (10% and 0%, respectively), with both 0% in CRSsNP group. The multiple linear regression analysis indicated that change ratio of FEV1 before and after bronchial provocation or dilation test were correlated with PBEC in CRSwNP group (β=0.403, P=0.006). CONCLUSION: CRS leading to impaired maximum ventilation and small airway is associated with the existence of nasal polyp. Lung function impairments can be reflected by PBEC, duration, VAS, and SNOT-20. In CRSwNP patients, PBEC is independent predictor of FEV₁ change ratio.
Bronchial Hyperreactivity ; Bronchial Provocation Tests ; Eosinophils ; Forced Expiratory Volume ; Humans ; Incidence ; Linear Models ; Lung* ; Nasal Polyps ; Otolaryngology ; Ventilation ; Vital Capacity

BACKGROUND: The measurement of nonspecific bronchial hyperreactivity is valuable for diagnosis and management of bronchial asthma. Methacholine or histamine is used for the pharmacologic provocation test. Usually a methacholine bronchial provocation test is performed by a dosing technique with counted number of breaths. A dosimeter is indispensable in the dosing technique. Recently a timed tidal breathing technique which dose not need an expensive dosimeter was introduced. We measured the degree of nonspecific bronchial hyperreactivity to histamine using a simple timed tidal breathing technique. METHOD: Forty two healthy volunteers, 12 patients with bronchial asthma(BA), 10 patients with rhinitis(RH) and 10 patients with upper respiratory infection(URI) participated in the study. The subject's nose was clipped and inhalation continued during tidal breathing for 2 minutes via a face mask. FEV1 was measured at 30 seconds, 90 seconds after inhalation and inhalation of next solution was continued until there was a fall in FEV1 of 20%. Histamine PC20 was defined as the concentration at 20% fall of FEV1 and it was obtained from the log dose-response curve by linear interpolation. RESULTS: Inhalation of serial dilution of histamine could be performed in all patients without significant side of effects. The geometric mean±standard deviation of histamine PC20 in healthy volunteers is 8.27±2.22mg/ml, BA group 0.33±3.02mg/ml, RH group 0.85 ±3.24mg/ml, and URI group 1.47±1.98mg/ml. CONCLUSION: Histamine bronchial provocation test using timed tidal breath method is a simple and suitable tool for management of patients with bronchial hyperreactivity.
Asthma ; Bronchial Hyperreactivity ; Bronchial Provocation Tests* ; Diagnosis ; Healthy Volunteers ; Histamine* ; Humans ; Inhalation ; Masks ; Methacholine Chloride ; Nose ; Respiration*

Adult ; Bronchial Hyperreactivity ; physiopathology ; Bronchial Provocation Tests ; Chronic Disease ; Cough ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Respiratory Function Tests

PURPOSE: Bronchial hyperresponsiveness is considered as a hallmark of asthma. The duration of asthma was demonstrated to be associated with bronchial responsiveness, expressed as methacholine PC20. We investigated the relationship between duration of asthma and percentage fall in forced vital capacity (FVC) at PC20 (DeltaFVC), another index of bronchial responsiveness, which reflects excessive bronchoconstriction. METHODS: Six- to 8-year-old children with asthma underwent methacholine inhalation test. The PC20 and DeltaFVC were calculated for each individual. The subjects were classified into those with wheezing onset in the first three years of life (early-onset asthma [EA], n=63) and those with wheezing onset from three years onwards (late-onset asthma [LA], n=99). RESULTS: From the time of wheezing onset, duration of asthma ranged from 0.2 to 8.3 years. The mean duration of asthma in patients with EA was 5.6 years (standard deviation [SD], 1.2 years), compared with 2.2 years (SD, 1.3 years) in the patients with LA. Patients with EA had a significantly lower forced expiratory volume in 1 second/FVC than did those with LA (84.6%+/-5.9% vs. 86.8%+/-5.1%, P<0.05). The DeltaFVC was significantly higher in patients with EA than in those with LA (19.4%+/-5.1% vs. 17.0%+/-4.5%, P<0.01), but PC20 was not different between the two groups. In total subjects, asthma duration correlated significantly with DeltaFVC (r=0.222, P<0.01), but not with PC20. CONCLUSION: These data suggest that prolonged asthma is associated with worsened bronchial responsiveness during childhood, and such an association may be reflected primarily by DeltaFVC rather than PC20.
Asthma* ; Bronchial Hyperreactivity ; Bronchoconstriction ; Child* ; Forced Expiratory Volume ; Humans ; Inhalation ; Methacholine Chloride ; Respiratory Sounds ; Vital Capacity