Chest
Volume 92, Issue 2, August 1987, Pages 313-318
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Histamine Challenge Test in Children Using Forced Oscillation to Measure Total Respiratory Resistance

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This study analyzed the relationship between total respiratory resistance (Rrs) measured by forced oscillation technique and FEV1 during histamine provocation test in 31 children between seven and 17 years of age. Rrs was measured at frequencies between 6 (R6) and 26 Hz (R26). (R6 – R26)/R26 was used as an index of frequency dependency of Rrs. A positive histamine test was defined as PC20 less than 8 mg/ml. Seventeen subjects had a positive test, and all of these had increases from baseline of R6 greater than 50 percent and (R6 – R26/R26 greater than 0.45. Of the 14 subjects whose PC20 was greater than 8 mg/ml, only two had changes in R6 and (R6—R26)/R26of this magnitude. These two subjects had changes in FEV1 of 16 and 18 percent. There was a strong linear relationship between the changes in FEV1 and both R6 and (R6 – R26)/R26 from baseline to the final value at the end of the test (r = 0.87 and 0.91 respectively). In conclusion, this study demonstrated that the evaluation of airway reactivity by histamine challenge may be done by forced oscillation technique. It is easy to administer and may allow testing of children unable to perform spirometry.

Section snippets

MATERIALS AND METHODS

The subjects for this study consisted of 31 Caucasian children between seven and 17 years of age who were referred for a histamine challenge test. Twelve were boys and 19 girls. No one was receiving medication at the time of the study. All had baseline values for total respiratory resistance (Rrs), measured by forced oscillation, that were within normal limits, 16 as were their baseline spirometry values. 17 Two-thirds had been referred because of symptoms suggestive of exercise-induced asthma,

RESULTS

There were 17 patients with a positive response to histamine as indicated by a PC20 of 8 mg/ml or less. These constituted group A, and the 14 subjects with negative test results made up group B. Allergic rhinitis was present in five members of group A and one of group B. Anthropometric data and mean baseline values for R6, R26, Rm, X26 and (R6 – R26)/R26 for both groups are given in Table 1. There was no significant difference in any of these parameters between the two groups. Range of baseline

DISCUSSION

Using the definition of a positive histamine challenge test as a PC20, not greater than 8 mg/ml, the method of forced oscillation to measure Rrs using a threshold of an increase in R6 of 50 percent or greater or an increase in (R6 – R26)/R26 of 0.45 or greater will include all positive tests; in other words, sensitivity of 100 percent. Those two patients whose PC20 was greater than 8 mg/ml but who were positive by the criteria of forced oscillation had changes in FEV1 of 16 and 18 percent. If,

REFERENCES (40)

  • P Konig et al.

    Forced random noise resistance determination in childhood asthma

    Chest

    (1984)
  • ANP Speight et al.

    Underdiagnosis and undertreatment of asthma in childhood

    Br Med J

    (1983)
  • AB DuBois et al.

    Oscillation mechanics of lungs and chest in man

    J Appl Physiol

    (1956)
  • MEB Wohl et al.

    Resistance of the respiratory system in healthy infants and infants with bronchiolitis

    Pediatrics

    (1969)
  • A Mansell et al.

    Measurement of respiratory resistance in children by forced oscillations

    Am Rev Respir Dis

    (1972)
  • J) Cogswell

    Forced oscillation technique for determination of resistance to breathing in children

    Arch Dis Child

    (1973)
  • LI Landau et al.

    Evaluation of two techniques for measurement of respiratory resistance by forced oscillation

    Thorax

    (1973)
  • N Rutter et al.

    Effect of bronchodilators on respiratory resistance in infants and young children with bronchiolitis and wheezy bronchiolitis

    Arch Dis Child

    (1975)
  • A Wanner et al.

    Continuous measurement of respiratory resistance in asthmatic children

    Respiration

    (1977)
  • H Aronson et al.

    A modified forced oscillation technique for measurements of respiratory resistance

    J Appl Physiol

    (1977)
  • W Lenney et al.

    At what age do bronchodilator drugs work?

    Arch Dis Child

    (1978)
  • W Lenney et al.

    Alpha and beta adrenergic stimulants in bronchiolitis and wheezy bronchitis in children under 18 months of age

    Arch Dis Child

    (1978)
  • D Stanescu et al.

    Frequency dependence of respiratory resistance in healthy children

    J Appl Physiol

    (1979)
  • SP Williams et al.

    Respiratory impedance and derived parameters in young children by forced random noise

    J Appl Physiol

    (1979)
  • D Berdel et al.

    Sollwerte fur den oszillatorischen atemwiderstand im kindesalter

    Prax Pneumol

    (1979)
  • ED Michaelson et al.

    Pulmonary mechanics by spectral analysis of forced random noise

    J Clin Invest

    (1975)
  • EJ Duiverman et al.

    Forced oscillation technique (Lándsér type). Reference values for resistance and reactance of the pulmonary system in healthy children aged 2.3 to 12.6 years

    Bull Eur Physiopathol Respir

    (1983)
  • ML Dickman et al.

    Spirometric standards for normal children and adolescents (ages 5 years through 18 years)

    Am Rev Respir Dis

    (1971)
  • RJ Knudson et al.

    The maximal expiratory flow-volume curve. Normal standards, variability and effects of age

    Am Rev Respir Dis

    (1976)
  • FJ Lándsér et al.

    A new method to determine frequency characteristics of the respiratory system

    J Appl Physiol

    (1976)
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    Supported by the Canadian Cystic Fibrosis Foundation and the McGill University Montreal Children’s Hospital Research Institute, Montreal, Canada.

    This is publication no. 87003 of the McGill University Montreal Children’s Hospital Research Institute.

    Manuscript received October 1; revision accepted January 27.

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