title: Maximal response plateau to adenosine 5'-monophosphate in asthma. Relationship with the response to methacholine, exhaled nitric oxide, and exhaled breath condensate pH.
abstract: BACKGROUND
  No information is available on the plateau in response to adenosine 5'-monophosphate(AMP). The aims of the present study were (1) to determine whether plateau can be detected with AMP and the relation with the plateau in response to methacholine, and (2) to identify the relation between the plateau and indirect markers of airway inflammation, such as exhaled nitric oxide (ENO) and exhaled breath condensate (EBC) pH.
  
  
  METHODS
  Airway responsiveness to high concentrations of methacholine and AMP, ENO levels, and EBC pH values were obtained in 31 subjects with well-controlled asthma. Concentration-response curves were characterized by their concentration of agonist that produces a decrease in FEV(1) of 20% and, if possible, by the level of plateau.
  
  
  RESULTS
  Although the prevalence of plateau with methacholine (48%) and AMP (58%) was similar, the two challenges did not identify plateau in exactly the same individuals. In 14 subjects who showed plateau with both bronchoconstrictor agents, the mean plateau level for methacholine was 26.0% (95% confidence interval [CI], 21.3 to 30.8), compared with 16.5% (95% CI, 12.2 to 20.8; p < 0.0001) for AMP. Both ENO and EBC pH values were similar in subjects with plateau and in those without plateau.
  
  
  CONCLUSIONS
  In well-controlled asthmatics, the plateau in response to AMP can be identified at a milder degree of obstruction than the plateau in response to methacholine, but the two agonists are not identifying the same airway abnormalities. Furthermore, if ENO and EBC pH are markers of inflammation, the determination of the presence or level of plateau is not a reliable method to identify airway inflammation in asthma.
authors.affiliation: Asociacion Valenciana de Investigaciones Clinicas, Valencia, Spain. Electronic address: prieto_jes@gva.es.
authors.forename: Luis
authors.initials: L
authors.lastname: Prieto
authors.affiliation: Servicio de Alergologia, Hospital Santiago Apostol, Vitoria, Spain.
authors.forename: Saioa
authors.initials: S
authors.lastname: Esnal
authors.affiliation: Asociacion Valenciana de Investigaciones Clinicas, Valencia, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Lopez
authors.affiliation: Asociacion Valenciana de Investigaciones Clinicas, Valencia, Spain.
authors.forename: Desire
authors.initials: D
authors.lastname: Barato
authors.affiliation: Asociacion Valenciana de Investigaciones Clinicas, Valencia, Spain.
authors.forename: Rocio
authors.initials: R
authors.lastname: Rojas
authors.affiliation: Universidad de Valencia, Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Marín
mesh_terms: D000249:Adenosine Monophosphate / Q000378:metabolism / Q000494:pharmacology*; D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy; D001944:Breath Tests; D016535:Bronchial Hyperreactivity / Q000139:chemically induced / Q000503:physiopathology*; D001985:Bronchial Provocation Tests / Q000379:methods; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D008297:Male; D020714:Maximum Tolerated Dose; D016210:Methacholine Chloride / Q000378:metabolism; D008875:Middle Aged; D009569:Nitric Oxide / Q000032:analysis* / Q000378:metabolism; D011336:Probability; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013147:Spirometry
chemical_list: D016210:Methacholine Chloride; D009569:Nitric Oxide; D000249:Adenosine Monophosphate