Abstract
Objective To provide a choice of drug for provocation test in clinic by comparing the diagnostic value and adverse effect between histamine bronchial provocation test (His-BPT) and methacholine bronchial provocation test (Mch-BPT). Methods 28 patients with asthma, 23 patients with cough post infection (CPI) were enrolled and 21 healthy subjects as volunteers.Accoding to a crossover-control design, all of the patients were assigned to group with His-BPT or Mch-BPT randomly.The sensitivity, specificity and adverse effect of this two provocation methods were compared. Results ①The sesitivit, specificity, accuracy, positive predictive value and negtive predictive value of His-BPT and Mch-BPT were 90% and 83%, 89% and 100%, 89% and 93%, 84% and 100%, 93% and 90% respectively.②Area under the ROC curve of the His-BPT is 0.959, the 95% confidence interval (0.916-1.001), P<0.01; The Mch-BPT is 0.957, the 95% confidence interval (0.901-1.013), P<0.01; ③The main adverse effect in asthmatic group with Mch-BPT or His-BPT were cough (His-BPT: 64.29%, Mch-BPT: 50%, P=0.10), throat-drying (His-BPT: 57.14%, Mch-BPT: 35.71%, P=0.17), short breath (His-BPT: 82.14%, Mch-BPT: 78.57%, P=0.92), chest tightness (His-BPT: 32.14%, Mch-BPT: 25%, P=0.40) respectively.The main adverse effect in CPI with Mch-BPT or His-BPT were cough (His-BPT: 66%, Mch-BPT: 44%, P<0.01), throat-drying (His-BPT: 43%, Mch-BPT: 57%, P=0.47), short breath (His-BPT: 22%, Mch-BPT: 19%, P=0.40). The incidence of cough and hoarseness in healty volunteers with His-BPT were significantly higher than those in volunteers with Mch-BPT (67% vs 38%; P<0.01; 29% vs 5%, P=0.05). Conclusions Both of His-BPT and Mch-BPT showed a high diagnostic value and no severe adverse effect, but a higher specificty and lower sensitivity were found in Mch-BPT.Though a high rate of adverse effect was found in His-BPT, subjects with adverse effect could received relief after related management.It was worth promoting the use of His-BPT and Mch-BPT in clinic widely. Key words: Bronchial provocation test; Histamine; Methacholine; Adverse effect
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