Methacholine challenge test: Diagnostic characteristics in asthmatic patients receiving controller medications
Background The methacholine challenge test (MCT) is commonly used to assess airway hyperresponsiveness, but the diagnostic characteristics have not been well studied in asthmatic patients receiving controller medications after the use of high-potency inhaled corticosteroids became common. Objectives...
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| creator | Sumino, Kaharu, MD, MPH Sugar, Elizabeth A., PhD Irvin, Charles G., PhD Kaminsky, David A., MD Shade, Dave, JD Wei, Christine Y., MS Holbrook, Janet T., PhD, MPH Wise, Robert A., MD Castro, Mario, MD, MPH |
| description | Background The methacholine challenge test (MCT) is commonly used to assess airway hyperresponsiveness, but the diagnostic characteristics have not been well studied in asthmatic patients receiving controller medications after the use of high-potency inhaled corticosteroids became common. Objectives We investigated the ability of the MCT to differentiate participants with a physician's diagnosis of asthma from nonasthmatic participants. Methods We conducted a cohort-control study in asthmatic participants (n = 126) who were receiving regular controller medications and nonasthmatic control participants (n = 93) to evaluate the sensitivity and specificity of the MCT. Results The overall sensitivity was 77% and the specificity was 96% with a threshold PC20 (the provocative concentration of methacholine that results in a 20% drop in FEV1 ) of 8 mg/mL. The sensitivity was significantly lower in white than in African American participants (69% vs 95%, P = .015) and higher in atopic compared with nonatopic (82% vs 52%, P = .005). Increasing the PC20 threshold from 8 to 16 mg/mL did not noticeably improve the performance characteristics of the test. African American race, presence of atopy, and lower percent predicted FEV1 were associated with a positive test result. Conclusions The utility of the MCT to rule out a diagnosis of asthma depends on racial and atopic characteristics. Clinicians should take into account the reduced sensitivity of the MCT in white and nonatopic asthmatic patients when using this test for the diagnosis of asthma. |
| doi_str_mv | 10.1016/j.jaci.2012.02.025 |
| format | Article |
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Objectives We investigated the ability of the MCT to differentiate participants with a physician's diagnosis of asthma from nonasthmatic participants. Methods We conducted a cohort-control study in asthmatic participants (n = 126) who were receiving regular controller medications and nonasthmatic control participants (n = 93) to evaluate the sensitivity and specificity of the MCT. Results The overall sensitivity was 77% and the specificity was 96% with a threshold PC20 (the provocative concentration of methacholine that results in a 20% drop in FEV1 ) of 8 mg/mL. The sensitivity was significantly lower in white than in African American participants (69% vs 95%, P = .015) and higher in atopic compared with nonatopic (82% vs 52%, P = .005). Increasing the PC20 threshold from 8 to 16 mg/mL did not noticeably improve the performance characteristics of the test. African American race, presence of atopy, and lower percent predicted FEV1 were associated with a positive test result. Conclusions The utility of the MCT to rule out a diagnosis of asthma depends on racial and atopic characteristics. Clinicians should take into account the reduced sensitivity of the MCT in white and nonatopic asthmatic patients when using this test for the diagnosis of asthma.</description><identifier>ISSN: 0091-6749</identifier><identifier>EISSN: 1097-6825</identifier><identifier>DOI: 10.1016/j.jaci.2012.02.025</identifier><identifier>PMID: 22465214</identifier><identifier>CODEN: JACIBY</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adolescent ; Adrenal Cortex Hormones - therapeutic use ; Adult ; Aged ; Allergies ; Allergy and Immunology ; Anti-Asthmatic Agents - therapeutic use ; Asthma ; Asthma - diagnosis ; Asthma - drug therapy ; atopy ; Biological and medical sciences ; Bronchial Hyperreactivity - diagnosis ; Bronchial Hyperreactivity - drug therapy ; Bronchial Provocation Tests - methods ; Child ; Chronic illnesses ; Chronic obstructive pulmonary disease, asthma ; Clinical trials ; Cohort Studies ; Cross-Sectional Studies ; Female ; Forced Expiratory Volume ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Humans ; Immunopathology ; inhaled corticosteroids ; Male ; Medical sciences ; Methacholine Chloride ; Middle Aged ; Pneumology ; Predictive Value of Tests ; race ; Respiratory Function Tests ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Sensitivity and Specificity ; Studies ; Treatment Outcome ; Young Adult</subject><ispartof>Journal of allergy and clinical immunology, 2012-07, Vol.130 (1), p.69-75.e6</ispartof><rights>American Academy of Allergy, Asthma & Immunology</rights><rights>2012 American Academy of Allergy, Asthma & Immunology</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jul 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c546t-1df438c034b3231a7de54e8238f37da6498c89691322efcad7253dfb381601bc3</citedby><cites>FETCH-LOGICAL-c546t-1df438c034b3231a7de54e8238f37da6498c89691322efcad7253dfb381601bc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0091674912003545$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26132800$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22465214$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sumino, Kaharu, MD, MPH</creatorcontrib><creatorcontrib>Sugar, Elizabeth A., PhD</creatorcontrib><creatorcontrib>Irvin, Charles G., PhD</creatorcontrib><creatorcontrib>Kaminsky, David A., MD</creatorcontrib><creatorcontrib>Shade, Dave, JD</creatorcontrib><creatorcontrib>Wei, Christine Y., MS</creatorcontrib><creatorcontrib>Holbrook, Janet T., PhD, MPH</creatorcontrib><creatorcontrib>Wise, Robert A., MD</creatorcontrib><creatorcontrib>Castro, Mario, MD, MPH</creatorcontrib><creatorcontrib>American Lung Association Asthma Clinical Research Centers</creatorcontrib><title>Methacholine challenge test: Diagnostic characteristics in asthmatic patients receiving controller medications</title><title>Journal of allergy and clinical immunology</title><addtitle>J Allergy Clin Immunol</addtitle><description>Background The methacholine challenge test (MCT) is commonly used to assess airway hyperresponsiveness, but the diagnostic characteristics have not been well studied in asthmatic patients receiving controller medications after the use of high-potency inhaled corticosteroids became common. Objectives We investigated the ability of the MCT to differentiate participants with a physician's diagnosis of asthma from nonasthmatic participants. Methods We conducted a cohort-control study in asthmatic participants (n = 126) who were receiving regular controller medications and nonasthmatic control participants (n = 93) to evaluate the sensitivity and specificity of the MCT. Results The overall sensitivity was 77% and the specificity was 96% with a threshold PC20 (the provocative concentration of methacholine that results in a 20% drop in FEV1 ) of 8 mg/mL. The sensitivity was significantly lower in white than in African American participants (69% vs 95%, P = .015) and higher in atopic compared with nonatopic (82% vs 52%, P = .005). Increasing the PC20 threshold from 8 to 16 mg/mL did not noticeably improve the performance characteristics of the test. African American race, presence of atopy, and lower percent predicted FEV1 were associated with a positive test result. Conclusions The utility of the MCT to rule out a diagnosis of asthma depends on racial and atopic characteristics. Clinicians should take into account the reduced sensitivity of the MCT in white and nonatopic asthmatic patients when using this test for the diagnosis of asthma.</description><subject>Adolescent</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Adult</subject><subject>Aged</subject><subject>Allergies</subject><subject>Allergy and Immunology</subject><subject>Anti-Asthmatic Agents - therapeutic use</subject><subject>Asthma</subject><subject>Asthma - diagnosis</subject><subject>Asthma - drug therapy</subject><subject>atopy</subject><subject>Biological and medical sciences</subject><subject>Bronchial Hyperreactivity - diagnosis</subject><subject>Bronchial Hyperreactivity - drug therapy</subject><subject>Bronchial Provocation Tests - methods</subject><subject>Child</subject><subject>Chronic illnesses</subject><subject>Chronic obstructive pulmonary disease, asthma</subject><subject>Clinical trials</subject><subject>Cohort Studies</subject><subject>Cross-Sectional Studies</subject><subject>Female</subject><subject>Forced Expiratory Volume</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Humans</subject><subject>Immunopathology</subject><subject>inhaled corticosteroids</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Methacholine Chloride</subject><subject>Middle Aged</subject><subject>Pneumology</subject><subject>Predictive Value of Tests</subject><subject>race</subject><subject>Respiratory Function Tests</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Sensitivity and Specificity</subject><subject>Studies</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0091-6749</issn><issn>1097-6825</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk2LFDEQhhtR3HH1D3iQBhG89JjvTosIsn7Cigf1HDLp6pmMPclsklnYf2-FGV3Yg0JICPXUm1S91TRPKVlSQtWr7XJrnV8yQtmS1CXvNQtKhr5Tmsn7zYKQgXaqF8NZ8yjnLcE718PD5owxoSSjYtGEr1A21m3i7AO0bmPnGcIa2gK5vG7fe7sOMRfvaihZVyD5es2tD63NZbOzNbjHHULJbQIH_tqHdetiKCmiWmp3MHqHRAz5cfNgsnOGJ6fzvPn58cOPi8_d5bdPXy7eXXZOClU6Ok6Ca0e4WHHGqe1HkAI043ri_WiVGLTTgxooZwwmZ8eeST5OK66pInTl-Hnz8qi7T_HqgLWYnc8O5tkGiIdsqFRKowrn_0cJY1pwpSiiz--g23hIAQtBQSI0E1IypNiRcinmnGAy--R3Nt2glKnGma2pxplqnCF1SUx6dpI-rLBff1P-OIXAixNgs7PzlGxwPt9y-D2mCUHuzZEDbO-1h2SyQ28ceoDmFDNG_-9_vL2T7nAy0L75F9xAvq3XZEww3-uI1QmjDN-WQvLfoUnLbg</recordid><startdate>20120701</startdate><enddate>20120701</enddate><creator>Sumino, Kaharu, MD, MPH</creator><creator>Sugar, Elizabeth A., PhD</creator><creator>Irvin, Charles G., PhD</creator><creator>Kaminsky, David A., MD</creator><creator>Shade, Dave, JD</creator><creator>Wei, Christine Y., MS</creator><creator>Holbrook, Janet T., PhD, MPH</creator><creator>Wise, Robert A., MD</creator><creator>Castro, Mario, MD, MPH</creator><general>Mosby, Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7SS</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20120701</creationdate><title>Methacholine challenge test: Diagnostic characteristics in asthmatic patients receiving controller medications</title><author>Sumino, Kaharu, MD, MPH ; Sugar, Elizabeth A., PhD ; Irvin, Charles G., PhD ; Kaminsky, David A., MD ; Shade, Dave, JD ; Wei, Christine Y., MS ; Holbrook, Janet T., PhD, MPH ; Wise, Robert A., MD ; Castro, Mario, MD, MPH</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c546t-1df438c034b3231a7de54e8238f37da6498c89691322efcad7253dfb381601bc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adrenal Cortex Hormones - therapeutic use</topic><topic>Adult</topic><topic>Aged</topic><topic>Allergies</topic><topic>Allergy and Immunology</topic><topic>Anti-Asthmatic Agents - therapeutic use</topic><topic>Asthma</topic><topic>Asthma - diagnosis</topic><topic>Asthma - drug therapy</topic><topic>atopy</topic><topic>Biological and medical sciences</topic><topic>Bronchial Hyperreactivity - diagnosis</topic><topic>Bronchial Hyperreactivity - drug therapy</topic><topic>Bronchial Provocation Tests - methods</topic><topic>Child</topic><topic>Chronic illnesses</topic><topic>Chronic obstructive pulmonary disease, asthma</topic><topic>Clinical trials</topic><topic>Cohort Studies</topic><topic>Cross-Sectional Studies</topic><topic>Female</topic><topic>Forced Expiratory Volume</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Humans</topic><topic>Immunopathology</topic><topic>inhaled corticosteroids</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Methacholine Chloride</topic><topic>Middle Aged</topic><topic>Pneumology</topic><topic>Predictive Value of Tests</topic><topic>race</topic><topic>Respiratory Function Tests</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Sensitivity and Specificity</topic><topic>Studies</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sumino, Kaharu, MD, MPH</creatorcontrib><creatorcontrib>Sugar, Elizabeth A., PhD</creatorcontrib><creatorcontrib>Irvin, Charles G., PhD</creatorcontrib><creatorcontrib>Kaminsky, David A., MD</creatorcontrib><creatorcontrib>Shade, Dave, JD</creatorcontrib><creatorcontrib>Wei, Christine Y., MS</creatorcontrib><creatorcontrib>Holbrook, Janet T., PhD, MPH</creatorcontrib><creatorcontrib>Wise, Robert A., MD</creatorcontrib><creatorcontrib>Castro, Mario, MD, MPH</creatorcontrib><creatorcontrib>American Lung Association Asthma Clinical Research Centers</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of allergy and clinical immunology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sumino, Kaharu, MD, MPH</au><au>Sugar, Elizabeth A., PhD</au><au>Irvin, Charles G., PhD</au><au>Kaminsky, David A., MD</au><au>Shade, Dave, JD</au><au>Wei, Christine Y., MS</au><au>Holbrook, Janet T., PhD, MPH</au><au>Wise, Robert A., MD</au><au>Castro, Mario, MD, MPH</au><aucorp>American Lung Association Asthma Clinical Research Centers</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Methacholine challenge test: Diagnostic characteristics in asthmatic patients receiving controller medications</atitle><jtitle>Journal of allergy and clinical immunology</jtitle><addtitle>J Allergy Clin Immunol</addtitle><date>2012-07-01</date><risdate>2012</risdate><volume>130</volume><issue>1</issue><spage>69</spage><epage>75.e6</epage><pages>69-75.e6</pages><issn>0091-6749</issn><eissn>1097-6825</eissn><coden>JACIBY</coden><abstract>Background The methacholine challenge test (MCT) is commonly used to assess airway hyperresponsiveness, but the diagnostic characteristics have not been well studied in asthmatic patients receiving controller medications after the use of high-potency inhaled corticosteroids became common. Objectives We investigated the ability of the MCT to differentiate participants with a physician's diagnosis of asthma from nonasthmatic participants. Methods We conducted a cohort-control study in asthmatic participants (n = 126) who were receiving regular controller medications and nonasthmatic control participants (n = 93) to evaluate the sensitivity and specificity of the MCT. Results The overall sensitivity was 77% and the specificity was 96% with a threshold PC20 (the provocative concentration of methacholine that results in a 20% drop in FEV1 ) of 8 mg/mL. The sensitivity was significantly lower in white than in African American participants (69% vs 95%, P = .015) and higher in atopic compared with nonatopic (82% vs 52%, P = .005). Increasing the PC20 threshold from 8 to 16 mg/mL did not noticeably improve the performance characteristics of the test. African American race, presence of atopy, and lower percent predicted FEV1 were associated with a positive test result. Conclusions The utility of the MCT to rule out a diagnosis of asthma depends on racial and atopic characteristics. Clinicians should take into account the reduced sensitivity of the MCT in white and nonatopic asthmatic patients when using this test for the diagnosis of asthma.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>22465214</pmid><doi>10.1016/j.jaci.2012.02.025</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adrenal Cortex Hormones - therapeutic use Adult Aged Allergies Allergy and Immunology Anti-Asthmatic Agents - therapeutic use Asthma Asthma - diagnosis Asthma - drug therapy atopy Biological and medical sciences Bronchial Hyperreactivity - diagnosis Bronchial Hyperreactivity - drug therapy Bronchial Provocation Tests - methods Child Chronic illnesses Chronic obstructive pulmonary disease, asthma Clinical trials Cohort Studies Cross-Sectional Studies Female Forced Expiratory Volume Fundamental and applied biological sciences. Psychology Fundamental immunology Humans Immunopathology inhaled corticosteroids Male Medical sciences Methacholine Chloride Middle Aged Pneumology Predictive Value of Tests race Respiratory Function Tests Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Sensitivity and Specificity Studies Treatment Outcome Young Adult |
| title | Methacholine challenge test: Diagnostic characteristics in asthmatic patients receiving controller medications |
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