But could such a less selective group, more compa­rable to a practical clinical setting, be used to establish sensitivity and specificity for challenge testing? Un­fortunately, there is no gold standard for the diagnosis of bronchial asthma, as there is for coronary artery disease or pulmonary embolism, where coronary and pulmonary angiography are considered diagnostic. If [...]

Continue reading " Post-Test Probability of Asthma Following Methacholine Challenge: DISCUSSION part 2 "

Since provocation testing usually continues until a positive test occurs or until approximately 200 CBU have been administered, we have presented only a single, 224 CBU curve for a negative test. The asthmatic patients of Casale et al were selected so that all had a positive test at this level or below. Studies on unselected [...]

Continue reading " Post-Test Probability of Asthma Following Methacholine Challenge: DISCUSSION "

The resulting curves are shown in Figure 1. The pretest probability is shown on the abscissa, the post- test probability on the ordinate. As an example, suppose a physician estimated that a nonsmoker had a 50 percent likelihood of asthma on the basis of history, physical examination, and laboratory infor­mation. If a methacholine challenge test [...]

Continue reading " Post-Test Probability of Asthma Following Methacholine Challenge: RESULTS "

The data of Casale and associates for nonatopic asymptomatic cigarette smokers and nonsmokers with and without asthma were used for the analysis. The nonsmoking nonasthmatic group excluded patients with an atopic or allergic background or with positive skin tests. Sensitivity (SE) is defined as the fraction of patients with the disease who have a positive test. [...]

Continue reading " Post-Test Probability of Asthma Following Methacholine Challenge: METHODS "

Tistamine and methacholine inhalation challenge are used extensively to determine bronchial reactivity and the likelihood of asthma in patients in whom the diagnosis is not obvious. Critical analyses, however, have shown that, as with all laboratory tests, there is overlap of results for normal and abnormal subjects. This overlap forces the physician to use decision [...]

Continue reading " Post-Test Probability of Asthma Following Methacholine Challenge "

Intercountry comparability is better for mortality in the 9th revision of the ICD than in the 8th revision. Unfortunately, only a few years of time trend data are available to date and it will be necessary to continue this observation during a longer period. Results of the present analysis suggest that it is necessary to [...]

Continue reading " Mortality from Chronic Obstructive Pulmonary Diseases and Asthma in France: DISCUSSION part 2 "

Analysis of US, Canadian and French mortality data shows lower death rates for COPD and asthma in France and dissimilar patterns by sex among these countries. The proportion of deaths from bronchitis was higher in France, while an increased use of generalized terms for COPD in death certificates was observed in Canada and the US. [...]

Continue reading " Mortality from Chronic Obstructive Pulmonary Diseases and Asthma in France: DISCUSSION "