Bronchial asthma is easily diagnosed if reversible bronchoconstriction can be demonstrated spirometrically. It becomes difficult if spirometric results are normal and the patient has intermittent coughing, dyspnea, or wheezing. The first induction of an asthma attack in the office was done in 1947 by Curry,1 who conducted challenges with methacholine (acetyl-β-methylcholine) and histamine in healthy persons and subjects with hay fever and asthma. However, bronchial hyperreactivity has only recently been included in the definition of asthma.2,3 The issue becomes more complicated, as recent studies of large populations have shown that bronchial hyperreactivity is not limited to asthma. Close relatives of probands with asthma—and even healthy persons with no family history of atopy or asthma—may demonstrate some degree of bronchial hyperreactivity.2-7
See also p 938.
Various means of inducing bronchial hyperreactivity have been developed and can be separated into pharmacologic, allergen, and natural challenges. Methacholine, histamine, acetylcholine, carbachol,
Bewtra A, Townley RG. Bronchoprovocative Tests: Clinical Usefulness and Limitations. Arch Intern Med. 1984;144(5):925–926. doi:10.1001/archinte.1984.00350170061008
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