Maximal airway narrowing in a general population.
James A., Lougheed D., Pearce-Pinto G., Ryan G., Musk B.
To characterize airway responses in a population sample, respiratory symptoms, smoking habits, and changes in FEV1 (delta FEV1) to inhaled methacholine (maximal cumulative dose of 196 mumol or maximal decrease in FEV1 of 50%) were recorded in 201 subjects. From each dose-response curve the plateau (delta FEV1 less than or equal to 5% over two or more dose steps) response, the maximal response (average of responses on the plateau or maximal delta FEV1 when no plateau was present), slope, and PD20 (dose required to cause delta FEV1 greater than 20%) were derived. The pattern of dose-response curves was a continuous change from being flat (maximal delta FEV1 less than or equal to 5%), becoming steeper with a plateau that occurred at a greater change in FEV1 as the curves were shifted more to the left, to being the steepest without a plateau response. Maximal delta FEV1 was significantly related to the PD20 (r = -0.64, p less than 0.001) and the slope (r = 0.63, p less than 0.001). A history of doctor-diagnosed asthma or wheeze in the last 12 months was related to the level of the maximal delta FEV1 and to PD20. Likelihood ratios [LR = sensitivity/(1-specificity)] for asthma or wheeze were higher for a maximal delta FEV1 of 50% plus a PD20 of 4 mumol (LR = 6.5) or 1 mumol (LR = 7) than for either alone. Subjects without reported asthma or wheeze more often had a plateau on the dose-response curve (76%) than those with a positive history (49%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)