Impulsna oscilometrija u proceni bronhijalne hipereaktivnosti kod bolesnika sa perzistentnim alergijskim rinitisom
Sažetak
Uvod/Cilj. Impulsna oscilometrija (IOS) je metod za procenu funkcije pluća koji se koristi za rano otkrivanje bronhijalne hiperreaktivnosti (BHR) i astme. Cilj rada je bio da se utvrde učestalost BHR, korelacija između IOS i spirometrije, senzitivnost i specifičnost IOS u dijagnozi BHR kod bolesnika sa perzistentnim alergijskim rinitisom. Metode. Od 81 ispitanika sa alergijskim rinitisom uzeta je anamneza, urađeno je alergološko testiranje, merenja funkcije pluća pomoću spirometrije i IOS pre i posle nespecifičnog bronhoprovokativnog testa (BPT) sa histaminom preko Aerosol provokacionog sistema. Merene su promene parametara IOS do pada FEV1 za 20% koje su upoređivane sa promenama spirometrijskih parametara. Nakon BPT ispitanici su bili podeljeni u grupu sa BHR (grupa 1) i bez BHR (grupa 2). Rezultati. Prosečno životno doba ispitanika iznosilo je 25,7 ± 5,7 godina, a 50,5% su bili muškaraci. Od ukupnog broja ispitanika sa alergijskim rinitisom 56 (58,9%) su imali pozitivan BPT. Posle bronhoprovokacije u grupi 1 prosečno povećanje za Rrs5 bilo je 88,15%, za Fres 111,98%, za AX 819,69%. Visok stepen korelacije dokazan je između IOS i spirometrije u grupi 2, dok je u grupi 1 utvrđena slaba korelacija između vrednosti parametara ova dva metoda. Dokazana je visoka senzitivnost i niska specifičnost za vrednosti Rrs5 i Fres u odnosu na FEV1 u dijagnostikovanju BHR. Zaključak. Dokazana je visoka prevalencija BHR u grupi pacijenata sa perzistentnim alergijskim rinitisom, loša korelacija u odnosu na spirometrijska merenja u grupi sa BHR i visoka osetljivost i niska specifičnost IOS u detekciji ranih promena u disajnim putevima.
Reference
1. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008. Update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63(Suppl 86): 8−160.
Global Initiative for Asthma, GINA. Global strategy for asthma management and prevention. 2014. Available from: http://www.ginasthma.org
World Allergy Organization. Rhinitis and asthma: "Combined allergic rhinitis and asthma syndrome". 2004. Available from: http:// www. worldallergy. org/public/allergic diseases cen-ter/caras/
Grbac I, Martinac S, Šokočevič M, Rončević S, Petrič V, Stančić V. The pathogenesis of bronchial hyperreactivity in patients with allergic rhinitis. Act Clin Croat 2003; 42(1): 69−74.
Antosova M, Strapkova A, Plevkova J. Bronchial hyperreactivity: Pathogenesis and treatment options. OJMIP 2011; 1(3): 43−51.
Feng CH, Mille MD, Simon RA. The united allergic airway: Connections between allergic rhinitis, asthma, and chronic si-nusitis. Am J Rhinol Allergy 2012; 26(3): 187−90.
Togias A. Rhinitis and asthma: Evidence for respiratory system integration. J Allergy Clin Immunol 2003; 111(6): 1171−83, quiz 1184.
Smith HJ, Reinhold P, Goldman MD. Forced oscillation technique and impulse oscillometry. Eur Respir Mon 2005; 31: 72−105.
Shi Y, Aledia AS, Tatavoosian АВ, Vijayalakshmi С, Galant SP, Georg SC. Relating small airways to asthma control by using impulse oscillometry in children. J Allergy Clin Immunol 2012; 129(3): 671−8.
Bickel S, Popler J, Lesnick B, Eid N. Impulse oscillometry inter-pretation and practical applications. Chest 2014; 146(3): 841−7.
Sterk PJ, Fabbri LM, Quanjer PH, Cockroft DW, O'Byrne PM, Anderson SD, et al. Airway responsivvness. Standardized chal-lenge testing with pharmacological, physical and sensitizing stimuli in adults. Eur Respir J 1993; 6(Suppl 16): 53−83.
Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, et al. Guidelines for methacholine and exercise chal-lenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med 2000; 161(1): 309−29.
Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PЈ, Burney PG, et al. Practical guide to skin prick tests in allergy to aeroallergens. Allergy 2012; 67(1): 18−24.
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005; 26(2): 319−38.
Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J 2005; 26(5): 948−68.
Koruga D. Aerosol provocation system (APS) the latest generati on Jaeger's system for bronchial provocation challenge. Pneumon 2006; 43: 77−84. (Serbian)
Mottram C, Ruppel G. Ruppel's manual of pulmonary function testing, 10th ed. St. Louis, MO: Elsevier-Mosby; 2013.
Kerkhof M, Schouten JP, De Monchy JG. The association of sensi-tization to inhalant allergens with allergy symptoms: the influ-ence of bronchial hyperresponsiveness and blood eosinophil count. Clin Exp Allergy 2000; 30(10): 1387−94.
Koruga D. Original lung function reports v4.52i for impulse oscillometry, spirometry and body plethysmo-graphy as designed in the Jaeger's software. Pneumon 2006; 43: 63−6. (Serbian)
Burgess JA, Walters EH, Byrnes GB, Matheson MC, Jenkins MA, Wharton CL, et al. Childhood allergic rhinitis predicts asthma incidence and persistence to middle age: A longitudinal study. Allergy Clin Immunol 2007; 120(4):863−9.
Kim YH, Park HB, Kim MJ, Kim HS, Lee HS, Han YK, at al. Fractional exhaled nitric oxide and impulse oscillometry in children with allergic rhinitis. Allergy Asthma Immunol Res 2014; 6(1): 27−32.
Komarow HD, Skinner J, Young M, Gaskins D, Nelson C, Gergen PJ, et al. A study of the use of impulse oscillometry in the evaluation of children with asthma: Analysis of lung parame-ters, order effect, and utility compared with spirometry. Pe-diatr Pulmonol 2012; 47(1): 18−26.
Jansen DF, Timens W, Kraan J, Rijcken B, Postma DS. (A)symptomatic bronchial hyper-responsiveness and asthma. Respir Med 1997; 91(3): 121−34.
Heppt W, Cryer A, Heermann R, Schultze-Werninghaus G. Wech-selwirkungen zwischen den oberen und unteren Atemwegen. Allergologie 2002; 2: 85−95.
Zhong NS, Chen RC, Yang MO, Wu ZY, Zheng JP, Li YF. Is asymptomatic bronchial hyperresponsiveness an indication of potential asthma?, A two year follow-up of young students with bronchial hyperresponsiveness. Chest 1992; 102(4): 1104−9.
Woolcoc AJ, Peat JK, Salome CM, Yan K, Anderson SD, Schoeffel RE, et al. Prevalence of bronchial hyper responsiveness and asthma in a rural adult population. Thorax 1987; 42(5): 361−8.
Valdesoiro L, Bosque M, Marco MT, Asensio O, Antón J, Larramona H. Allergic rhinitis and bronchial hyperreactivity. Allergol Immunopathol 2004; 32(6): 340−3. (Spanish)
Cuttitta G, Cibella F, La Grutta S, Hopps MR, Bucchieri S, Passa-lacqua G, et al. Non-specific bronchial hyper-responsiveness in children with allergic rhinitis: relationship with the atopic sta-tus. Pediatr Allergy Immunol 2003; 14(6): 458−63.
Riccioni G, Della Vecchia R, Castronuovo M, Di Pietro V, Spoltore R, De Benedictis M, et al. Bronchial hyperresponsiveness in adults with seasonal and perennial rhinitis: is there a link for asthma and rhinitis? Int J Immunopathol Pharmacol 2002; 15(1): 69−74.
Gaur SN, Kumar R, Lohia AK, Agarwal K. Sensitivity to com-mon aeroallergens in allergic rhinitis as a predictor of bronchi-al hyperreactivity and development of asthma. Indian J Allergy Asthma Immunol 2011; 25(2): 61−6.
Park HB, Kim YH, Kim MJ, Kim HS, Lee HS, Han YK, et al. Forced expiratory flow between 25% and 75% of vital capacity as a predictor for bronchial hyperresponsiveness in children with allergic rhinitis. Allergy Asthma Respir Dis 2013; 1(1): 60−6.
Goldman MD, Carter R, Klein R, Fritz G, Carter B, Pachucki P. Within-and between-day variability of respiratory impedance, using impulse oscillometry in adolescent asthmatics. Pediatr Pulmonol 2002; 34(4): 312−9.
Skiepko R, Zietkowski Z, Tomasiak-Lozowska MM, Tomasiak M, Bodzenta-Lukaszyk A. Bronchial hyperresponsiveness and air-way inflammation in patients with seasonal allergic rhinitis. J Investig Allergol Clin Immunol 2011; 21(7): 532−9.
Marotta A, Klinnert MD, Price MR, Larsen GL, Liu AH. Impulse oscillometry provides an effective measure of lung dysfunction in 4-year-old children at risk for persistent asthma. J Allergy Clin Immunol 2003; 112(2): 317−22.
Schulze J, Smith HJ, Fuchs J, Herrmann E, Dressler M, Rose MA, et al. Methacholine challenge in young children as evaluated by spirometry and impulse oscillometry. Respir Med 2012; 106(5): 627−34.
Shin YH, Jang SJ, Yoon JW, Jee HM, Choi SH, Yum HY, et al. Oscillometric and spirometric bronchodilator response in pre-school children with and without asthma. Can Respir J 2012; 19(4): 273−7.