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• W2078165320 abstract "To the Editor:We read with great interest the article by Filuk, Serrette and Anthonisen (“Comparison of Responses to Methacholine and Cold Air in Patients Suspected of Having Asthma,” Chest 1989; 95:94852). The results they present are very close to what we previously published.1Desjardins A De Luca S Cartier A L'Archevêque J Ghezzo H Malo JL Nonspecific bronchial hyperresponsiveness to inhaled histamine and hyperventilation of cold dry air in subjects with respiratory symptoms of uncertain etiology.Am Rev Respir Dis. 1988; 137: 1020-1025Crossref PubMed Scopus (19) Google Scholar One conclusion shared by these authors, others2Boulet LP Legris C Thibault L Turcotte H Comparative bronchial responses to hyperosmolar saline and methacholine in asthma.Thorax. 1987; 42: 953-958Crossref PubMed Scopus (24) Google Scholar and ourselves is that the correspondence between the methods of assessing bronchial responsiveness with different stimuli is not very satisfactory. This is indeed puzzling and the mechanism for this warrants fundamental study.However, from a practical point of view, we do not think that this supports the conclusion that “neither test constitutes a ‘gold standard' for the diagnosis of asthma”. First, using pharmacologic agents or hyperventilation assesses the presence of bronchial responsiveness and not asthma. Secondly, whereas the histamine or methacholine test which the authors used has been well standardized and correlated with the severity of asthma and the need for medication, this has not been assessed using hyperventilation, especially with the “all or nothing” response test which the authors propose. Thus, the only situation for which performing an hyperventilation test might be interesting would be for those subjects with a negative pharmacologic test. However, only 12 of 77 (16 percent) of the subjects in Filuk et als study had a positive cold air challenge in the absence of bronchial hyperresponsiveness to methacholine. The corresponding figure was seven of 50 (14 percent) in our study.1Desjardins A De Luca S Cartier A L'Archevêque J Ghezzo H Malo JL Nonspecific bronchial hyperresponsiveness to inhaled histamine and hyperventilation of cold dry air in subjects with respiratory symptoms of uncertain etiology.Am Rev Respir Dis. 1988; 137: 1020-1025Crossref PubMed Scopus (19) Google Scholar We thus concluded that “the low frequency of its presence in the absence of significant bronchial responsiveness to histamine does not justify the routine use of cold air challenge in addition to the histamine test”,1Desjardins A De Luca S Cartier A L'Archevêque J Ghezzo H Malo JL Nonspecific bronchial hyperresponsiveness to inhaled histamine and hyperventilation of cold dry air in subjects with respiratory symptoms of uncertain etiology.Am Rev Respir Dis. 1988; 137: 1020-1025Crossref PubMed Scopus (19) Google Scholar a conclusion which we would like to propose for discussion by the authors. To the Editor: We read with great interest the article by Filuk, Serrette and Anthonisen (“Comparison of Responses to Methacholine and Cold Air in Patients Suspected of Having Asthma,” Chest 1989; 95:94852). The results they present are very close to what we previously published.1Desjardins A De Luca S Cartier A L'Archevêque J Ghezzo H Malo JL Nonspecific bronchial hyperresponsiveness to inhaled histamine and hyperventilation of cold dry air in subjects with respiratory symptoms of uncertain etiology.Am Rev Respir Dis. 1988; 137: 1020-1025Crossref PubMed Scopus (19) Google Scholar One conclusion shared by these authors, others2Boulet LP Legris C Thibault L Turcotte H Comparative bronchial responses to hyperosmolar saline and methacholine in asthma.Thorax. 1987; 42: 953-958Crossref PubMed Scopus (24) Google Scholar and ourselves is that the correspondence between the methods of assessing bronchial responsiveness with different stimuli is not very satisfactory. This is indeed puzzling and the mechanism for this warrants fundamental study. However, from a practical point of view, we do not think that this supports the conclusion that “neither test constitutes a ‘gold standard' for the diagnosis of asthma”. First, using pharmacologic agents or hyperventilation assesses the presence of bronchial responsiveness and not asthma. Secondly, whereas the histamine or methacholine test which the authors used has been well standardized and correlated with the severity of asthma and the need for medication, this has not been assessed using hyperventilation, especially with the “all or nothing” response test which the authors propose. Thus, the only situation for which performing an hyperventilation test might be interesting would be for those subjects with a negative pharmacologic test. However, only 12 of 77 (16 percent) of the subjects in Filuk et als study had a positive cold air challenge in the absence of bronchial hyperresponsiveness to methacholine. The corresponding figure was seven of 50 (14 percent) in our study.1Desjardins A De Luca S Cartier A L'Archevêque J Ghezzo H Malo JL Nonspecific bronchial hyperresponsiveness to inhaled histamine and hyperventilation of cold dry air in subjects with respiratory symptoms of uncertain etiology.Am Rev Respir Dis. 1988; 137: 1020-1025Crossref PubMed Scopus (19) Google Scholar We thus concluded that “the low frequency of its presence in the absence of significant bronchial responsiveness to histamine does not justify the routine use of cold air challenge in addition to the histamine test”,1Desjardins A De Luca S Cartier A L'Archevêque J Ghezzo H Malo JL Nonspecific bronchial hyperresponsiveness to inhaled histamine and hyperventilation of cold dry air in subjects with respiratory symptoms of uncertain etiology.Am Rev Respir Dis. 1988; 137: 1020-1025Crossref PubMed Scopus (19) Google Scholar a conclusion which we would like to propose for discussion by the authors. Testing for AsthmaCHESTVol. 97Issue 4PreviewTo the Editor: Full-Text PDF" @default.
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• W2078165320 title "Testing for Asthma" @default.
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