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• W2037459056 abstract "One of the most useful techniques in the investigation of asthma and occupational lung disease is bronchial challenge, or bronchoprovocation. It has been well documented that asthmatic subjects have greater airway reactivity than normal individuals when exposed to a variety of substances.1Fish J Rosenthal R Batra G et al.Airway responses to methacholine in allergic and non-allergic subjects.Am Rev Respir Disease. 1976; 113: 579-586PubMed Google Scholar Although cholinergic agents (eg methacholine) and histamine have been the most extensively studied, asthmatic subjects may show this hyperreactivity to other substances, such as prostaglandins.2Mathé A Hedqvist P Holmgren A et al.Bronchial hyperreactivity to prostaglandin FL and histamine in patients with asthma.Br Med J. 1973; 1: 193Crossref PubMed Scopus (157) Google Scholar This increased reactivity to chemical mediators is uniform among all asthmatics, regardless of the etiology of the asthma. Bronchoprovocation, bronchial challenge, or inhalation challenge are terms used to describe the technique whereby subjects are given carefully graded inhalation doses of a given agent until a predetermined end point in bronchial reactivity is reached.3Chai H Farr R Froehlich L et al.Standardization of bronchial inhalation challenge procedures.J Allergy Clin Immunol. 1975; 56: 323-327Abstract Full Text PDF PubMed Scopus (1142) Google Scholar This technique has been used as a confirmatory test for asthma,4Easton J The value of inhalation challenge testing as an office procedure.Ann Allergy. 1975; 35: 234-238PubMed Google Scholar as well as a tool to investigate occupational asthma and to study the pathophysiology of human asthma. The bronchial response to histamine has been well studied. As with methacholine, asthmatic subjects demonstrate an increased bronchial reactivity to this chemical mediator.5Cockcroft D Killian D Mellon J et al.Bronchial reactivity to inhaled histamine: a method and clinical survey.Clin Allergy. 1977; 7: 235-243Crossref PubMed Scopus (1481) Google Scholar The mechanism by which histamine effects this change was formerly thought to be primarily a vagal reflex, as is seen with many pulmonary irritants.6Golden J Nadel J Boushey H Bronchial hyperirritability in healthy subjects after exposure to ozone.Am Rev Respir Dis. 1978; 118: 287-294PubMed Google Scholar More recent studies have shown that the histamine response is unlikely to be vagally mediated because histamine-induced bronchoconstriction cannot be prevented by anticholinergic agents.7Casterline C Evans R Ward G The effect of atropine and albuterol aerosols on the human bronchial response to histamine.J Allergy Clin Immunol. 1976; 58: 607-613Abstract Full Text PDF PubMed Scopus (52) Google Scholar, 8Cockcroft D Killian D Mellon J et al.Protective effect of drugs on histamine-induced asthma.Thorax. 1977; 32: 429-437Crossref PubMed Scopus (113) Google Scholar, 9Woenne R Kattan M Orange R et al.Bronchial hyperreactivity to histamine and methacholine in asthmatic children after inhalation of SCH 1000 and chlorpheniramine maleate.J Allergy Clin Immunol. 1978; 62: 119-124Abstract Full Text PDF PubMed Scopus (42) Google Scholar Inhaled histamine has been shown to have a direct effect on histamine receptor sites, independent of cholinergic or irritant receptors.10Casterline C, Evans R: Further studies on the mechanism of human histamine-induced asthma. J Allergy Clin Immunol 59:420-424, 1977Google Scholar Occupational asthma from exposure to a variety of organic and inorganic substances has been increasingly recognized in recent years. Studies have shown that dust, vapors, and fumes can cause asthma through several mechanisms: direct irritant or toxic effect (TDI asthma), IgE-mediated reaction (platinum, papain, B subtilis), or by induction of aberrations in mediator release and pharmacologic pathways (byssinosis).11Davies R, Selvaggio J: Occupational asthma: how to recognize, treat and prevent it Consultant 201-216, Oct 1978Google Scholar In certain occupational lung diseases, appropriate allergens have not been defined or are not available for bronchial challenge. Similarly, simulation of the actual work environment is impractical or not feasible. However, quantitation of nonspecific bronchial reactivity, such as induced by methacholine or histamine, is readily available, safe and easy to perform, and yields valuable information. Tests can be repeated after removal from exposure to the offending antigen, or throughout the course of the continued exposure to the antigen. Lan and Wong12Lam S Wong R Yeung M Nonspecific bronchial reactivity in occupational asthma.J Allergy Clin Immunol. 1979; 63: 28-34Abstract Full Text PDF PubMed Scopus (145) Google Scholarrecently utilized this method to study a series of patients with occupational asthma. Decreased bronchial hyperreactivity after removal from exposure, and increased hyperreactivity following reexposure, suggested that it was a result rather than a predisposing factor in occupational asthma. Other recent studies have linked bronchial hyperreactivity with HLA haplotype and atopy, suggesting a predisposition to the development of asthma in such individuals.13Easton J Brady R Kaplan M et al.Studies on the relationship of bronchial hyperreactivity to methacholine and HLA haplotypes in asthmatic families.J Allergy Clin Immunol. 1978; 61: 158Abstract Full Text PDF Scopus (1) Google Scholar Grain dust is a heterogeneous substance that may include particles from numerous cereal grains, and may contain a large number of contaminants including silica, fungi and their metabolites (aflatoxin), bacterial endotoxins, insects, mites, mammalian debris and various chemical additives such as pesticides and herbicides. The health effects of these various components is unknown.14Cotton D Dosman J Grain dust and health.III Environmental factors. Ann Int Med. 1978; 89: 420-421Crossref PubMed Scopus (19) Google Scholar Bronchoprovocation tests with aqueous extracts of mixed grain dust and of mixed fungal spores have been performed in grain workers. Although specific bronchial reactivity can be tested, it has been suggested that nonspecific bronchial reactivity may be an earlier indicator of lung dysfunction.15Dosman J Cotton D Grain dust and health.II Early diagnosis in occupational disease. Ann Int Med. 1978; 89: 134-135PubMed Google Scholar In this issue of Chest, Mink and colleagues (see page 28) studied nonspecific bronchial reactivity to inhaled histamine in nonsmoking grain handlers. When compared to an age and sex matched control group, the grain handlers demonstrated increased nonspecific bronchial reactivity, as well as increased respiratory symptoms. The investigators concluded that chronic exposure to grain dust in nonallergic individuals is associated with increased prevalence of respiratory symptoms and increased nonspecific bronchial reactivity. This correlation was not related to duration of grain dust exposure and may be a factor in the pathogenesis of lung disease in grain workers. The bronchial reactivity was greater in the grain workers, even though the degree of atopy was slightly greater in the control group. One would wonder whether continued monitoring of bronchial reactivity throughout years of continued exposure to grain dust would be helpful in prognosticating which individuals might be more prone to develop long-term adverse effects from grain dust. In summary, bronchoprovocation is a useful new tool among the physician's diagnostic and investigational resources. It is safe, reproducible, noninvasive and readily available in most areas. Future application of this technique may include large-scale assessment of industrial populations, particularly in regard to disability. Routine use of this test offers a real way to monitor patients in high risk occupations, and perhaps to prevent the development of disease that may have chronic and irreversible effects from continued exposure." @default.
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• W2037459056 title "Irritable Airways" @default.
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