Calculation of provocative concentration causing a 20% fall in FEV(1): comparison of lowest vs highest post-challenge FEV(1).
BACKGROUND
Considerable, unexamined controversy exists surrounding the use of the highest vs the lowest FEV(1) for calculating the provocative concentration causing a 20% fall in FEV(1) (PC(20)) during direct bronchoprovocation challenges.


OBJECTIVE
To compare the PC(20) calculated using the lowest FEV(1) post-diluent and post-histamine/methacholine vs the PC(20) calculated using the highest FEV(1) post-diluent and post-histamine/methacholine.


METHODS
Retrospective analysis of 225 challenges: 75 research methacholine challenges, 75 research histamine challenges, and 75 clinical methacholine challenges. For each test, the PC(20) was calculated twice, first using the lowest post-diluent FEV(1) to the lowest post-histamine/methacholine FEV(1), and then using the highest to the highest.


RESULTS
The intraclass correlation coefficients for methacholine research, histamine research, and methacholine clinic challenges were 0.99, 0.98, and 0.95, respectively. The PC(20) calculated using the lowest to lowest FEV(1) was slightly and significantly lower in all three groups (paired t test p < 0.0001).


CONCLUSIONS
The PC(20) values calculated using the highest FEV(1) are almost identical to the PC(20) values calculated using the lowest FEV(1). The difference, although clinically irrelevant, holds statistical significance.
Davis
B E
BE
Division of Respiratory Medicine, Department of Medicine, Royal University Hospital, Saskatoon, Canada.
Cockcroft
D W
DW
D016535:Bronchial Hyperreactivity / Q000175:diagnosis*; D001985:Bronchial Provocation Tests / Q000379:methods*; D016085:Bronchoconstrictor Agents / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005541:Forced Expiratory Volume / Q000187:drug effects*; D006632:Histamine / Q000008:administration & dosage; D006801:Humans; D016210:Methacholine Chloride / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012189:Retrospective Studies
D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride; D006632:Histamine