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Vol. 29. Núm. 5.
Páginas 212-219 (Junio - Julio 1993)
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Vol. 29. Núm. 5.
Páginas 212-219 (Junio - Julio 1993)
DOI: 10.1016/S0300-2896(15)31214-X
Acceso a texto completo
Características de la respuesta de las vías aéreas a la inhalación de concentraciones altas de metacolina en pacientes con rinitis y PC20 en rango asmático
The characteristics of airway response to the inhalation of high concentrations of methacholine in patients with rhinitis and PC20 in an asthmatic range
Visitas
...
L. Prieto, J. Manuel Bertó
Unidad de Alergia (Servicio de M. Interna). Hospital Dr. Peset
A. Peris*, M.D. Hernández*
* Servicio de Alergia. Hospital La Fe. Valencia
Información del artículo

En la mayoría de estudios realizados en pacientes con rinitis alérgica, se ha definido la hiperrespuesta bronquial a los agonistas farmacológicos mediante valores de la PC20 o PD20 inferiores a un punto de corte predefinido. Para estudiar las características de la respuesta bronquial a metacolina en pacientes con rinitis y PC20 en rango asmático, identificamos, en un primer grupo de 20 voluntarios con rinitis polínica (a los que se les intentó inducir caídas del FEV1 > 50%), un grado de obstrucción que resultase seguro para su utilización en clínica y analizamos la relación entre la PC20, posición y respuesta máxima-plateau. En una segunda fase del estudio, se usaron concentraciones altas de metacolina en 52 pacientes con rinitis alérgica (20 perenne y 32 estacional), 23 individuos con rinitis perenne no alérgica y 27 asmáticos. En los sujetos de estas tres poblaciones con PC20 en rango asmático, se prolongó la exploración hasta inducir caídas del FEV1 > 40% (el grado de obstrucción identificado previamente como seguro y más rentable) o hasta administrar la concentración más alta (200 mg/ml) de metacolina.

En el grupo inicial de 20 pacientes, se objetivó que las caídas del FEV1, de hasta el 40% eran generalmente bien toleradas, sin más efectos colaterales que la sialorrea y permitían identificar plateau en una amplia proporción de individuos. Se encontró una correlación entre el log PC20 y el nivel del plateau (r=–0,78, p<0,01), pero no hubo correlación significativa entre EC50 y el nivel del plateau (rs=0.013, p > 0,05), ni entre PC20 y EC50 (rs=0,44, p > 0,05). En la segunda fase del estudio, se detectaron valores de la PC20 en rango asmático en 24 de los 52 pacientes con rinitis alérgica y en dos de los 23 con rinitis perenne no alérgica (p<0.01). Se identificó plateau en 10 de los 24 pacientes con rinitis alérgica y PC20 en rango asmático y en uno de los 26 pacientes asmáticos con PC20 en rango asmático (p<0.01). No se observaron diferencias significativas entre los pacientes con rinitis alérgica perenne y estacional.

El concepto de hiperrespuesta bronquial a los agonistas farmacológicos tiene implicaciones más amplias que la simple determinación de la PC20 y, cuando se estudien las características de la respuesta bronquial a los agonistas farmacológicos en los pacientes con rinitis alérgica, debe de tenerse en cuenta la posibilidad de obtener curvas concentración-respuesta completas en aproximadamente la mitad de los individuos con valores de la PC20 en rango asmático.

In most of the studies performed in patients with allergic rhinitis, the bronchial hyperresponse to pharmacologic agonists has been defined by PC20 or PD20 values lower than a predefined cut off point. To study the caracteristics of bronchial response to methacholine in patients with rhinitis and PC20 in the asthmatic range, a grade of obstruction which was safe for clinical use was identified in a group of 20 volunteers with polynic rhinitis (in whom the induction of FEV1 falls > 50% were attempted) and the relation between PC20, position and maximum plateau response was analyzed. In the second phase of the study high concentrations of methacholine were used in 52 patients with allergic rhinitis (20 perennial and 32 seasonal), 23 individuals with non allergic perennial rhinitis and 27 asthmatic subjects. In the subjects of these three populations who had PC20 in the asthmatic range, the exploration was prolonged until falls of FEV1 40% (the grade of obstruction previously identified as safe and more advantageous) were induced or until the highest concentration of methacholine (200 mg/ml) was administred.

In the initial group of 20 patients falls of FEV1 of up to 40% were generally observed to be well tolerated with no side effects other than sialorrhea allowing a plateau to be identified in a large number of individuáis. A correlation was found between the log PC20 and the level of the plateau (r=–0.78; p<0.01). There was no significant correlation between EC50 and the plateau level (rs=0.013; p<0.05) or between PC20 and EC50 (rs=0.44; p<0.05). In the second phase of the study PC20 values in the asthmatic range were detected in 24 out of the 52 patients with allergic rhinitis and in 2 out of the 23 patients with non allergic perennial rhinitis (p<0.01). The plateau was identified in 10 out of the 24 patients with allergic rhinitis and asthmatic range PC20 and in one of the 26 asthmatic patients with asthmatic range PC20 (p<0.01). No significant differences were observed between the patients with perennial and seasonal allergic rhinitis.

The concept of bronchial hyperresponse to pharmacologic agonists has implications which are more widespread than the simple determination of PC20 and when the characteristics of bronchial response to pharmacologic agonists is studied in patients with allergic rhinitis the possibility of obtaining complete concentration-response curves in approximately half of the individuals with asthmatic range PC20 should be kept in mind.

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