title: Clinical variables are poor selection criteria for the use of methacholine bronchoprovocation in symptomatic subjects.
abstract: OBJECTIVE
  Airway hyperresponsiveness (AHR) is associated with persistent air flow limitation and accelerated FEV(1) decline. AHR can influence diagnosis, treatment, and prognosis. We assessed the value of pulmonary function variables, symptoms, and history as selection criteria for methacholine bronchoprovocation testing to detect AHR in symptomatic subjects.
  
  
  METHODS
  Over a 4-year period we conducted a prospective study of consecutive subjects who underwent methacholine bronchoprovocation testing. Baseline pulmonary function testing (PFT) and a questionnaire were obtained prior to methacholine bronchoprovocation testing. PFT and symptom and history variables were assessed as AHR predictors in univariate and multiple logistic regression analyses for the whole group and for 4 different age groups.
  
  
  RESULTS
  There were 530 subjects, with ages ranging from 5 to 87 years, and 232 (44%) were positive for methacholine AHR. AHR was more prevalent among subjects < or = 25 years old (59%) and > 65 years old (47%) than among the other age groups. PFT values, symptom, and history variables had different AHR predictive values among the different age groups. Symptom and history variables had no AHR predictive value among subjects < or = 25 or > 65 years old.
  
  
  CONCLUSIONS
  Young and elderly symptomatic subjects are more likely to have methacholine AHR. None of the clinical variables we studied has significant predictive value for methacholine AHR across the age groups, so these variables are poor selection criteria for methacholine bronchoprovocation testing of symptomatic subjects. Given the high prevalence of AHR among these subjects, bronchoprovocation should be considered with all individuals who have respiratory symptoms of wheezing, cough, shortness of breath, or chest tightness.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA. annie_parker@brown.edu
authors.forename: Annie Lin
authors.initials: AL
authors.lastname: Parker
authors.forename: Muhanned
authors.initials: M
authors.lastname: Abu-Hijleh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001985:Bronchial Provocation Tests; D016085:Bronchoconstrictor Agents; D002648:Child; D002675:Child, Preschool; D006801:Humans; D016210:Methacholine Chloride; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012130:Respiratory Hypersensitivity / Q000175:diagnosis* / Q000503:physiopathology*
chemical_list: D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride