Apport du test de provocation bronchique non spécifique dans le diagnostic d’asthme et d’inaptitude des militaires tunisiens

Abstract

ObjectiveWe aimed to evaluate the value of the methacholine challenge test (MCT) in patients with asthma symptoms but without spirometric criteria and to determine the professional impact of asthma diagnosis by MCT in a Tunisian military population. Materials and methodsThis was a retrospective study conducted in the pulmonology department of the main military hospital in Tunis between November 2014 and March 2018 among soldiers with suspected asthma referred for aptitude assessment. All patients underwent spirometry followed by MCT. ResultsDuring the study period, 291 patient files were collected. The average age was 24.4 years (range: 18 to 48). All patients were male and exhibited bronchial hyperresponsiveness (BHR) with methacholine doses ranging from 100 to 1100μg (mean dose: 488μg). PD20 was between 100 and 400 in 45.4% of subjects compared with 400–800 in 30.9% and in 800–1100 in 23.7%. The degree of bronchoconstriction ranged from 20 to 55%. Mean bronchoconstriction in the smoking group was 32.7% vs. 20.3% in the non-smoking group (P=0.04). Bronchoconstriction was greater in the presence of rhinoconjunctivitis: 35.8% vs. 22.9% (P=0.02). We found no correlation between BHR, obesity and levels of IgE and eosinophilia. There was no correlation between the severity of HRB and sinonasal polyposis. All subjects were declared unfit for military service. ConclusionIn addition to clinical history, methacholine challenge testing plays a significant role in the diagnosis of asthma and medical screening for military service.