Open AccessUtility of hypertonic histamine challenge in distinguishing difficult‐to‐diagnose asthma
Author(s) -
Purokivi Minna,
Koskela Heikki O.,
Koistinen Tiina,
Magga Jarkko,
Peuhkurinen Keijo,
Kiviniemi Vesa,
Kontra Kirsi M.
Publication year - 2007
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/j.1752-699x.2007.00016.x
Subject(s) - medicine , asthma , histamine , copd , airway hyperresponsiveness , receiver operating characteristic , outpatient clinic , pediatrics , anesthesia
Although classical asthma is associated with airway hyperresponsiveness (AHR), this condition is also present in many cardiopulmonary disorders undermining the rational basis of its measurement in the differential diagnosis of asthma. We have recently introduced a new method to investigate AHR, the hypertonic histamine challenge (HHC). Objective: The aim of this study was to evaluate the differential diagnostic power of HHC in a clinically representative sample of 138 patients. Methods: Fifty‐seven patients from the outpatient clinic of the authors' hospital with symptoms indicative of asthma were consecutively recruited. Asthma was confirmed in 31 subjects. The remaining 26 subjects formed the control group, in conjunction with seven patients with COPD, 15 patients with interstitial lung disease, 21 patients with rhinitis, 13 patients with heart failure and 25 healthy controls. Hypertonic histamine solution was administered with an ultrasonic nebuliser. Results: Only the PC 20 values of asthmatic subjects differed statistically significantly from those of the healthy group ( P < 0.0001). The receiver operator characteristic curve indicated that a PC 20 value of 0.83 mg/mL would be the optimal cut‐off point of HHC to separate the asthmatics from the symptomatic controls with a sensitivity of 81% and specificity of 70%. With the PC 20 values of 0.1 and 4.0 mg/mL, the sensitivities were 42% and 100%, and the specificities were 96% and 40%, respectively. In these limits, HHC either confirmed or excluded asthma in 64 out of 138 patients (46%). Conclusion: The authors' attempt to improve the accuracy of the airway challenge test by combining direct and indirect challenges did not overcome the diagnostic limitations of previously utilised airway challenges. Please cite this paper as: Purokivi M, Koskela HO, Koistinen T, Magga J, Peuhkurinen K, Kiviniemi V and Kontra KM. Utility of hypertonic histamine challenge in distinguishing difficult‐to‐diagnose asthma. The Clinical Respiratory Journal 2007; 1:91–98.