in Asthmology Methods Luigi Allegra. Pier Carlo Braga Roberto Dal Negro (Eds.)

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2 Luigi Allegra. Pier Carlo Braga Roberto Dal Negro (Eds.) Methods in Asthmology With 107 Figures and 53 Tables Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona Budapest

3 Luigi Allegra, M.D. Istituto di Malattie Respiratorie Policlinico - Pad. Litta, Via F. Sforza, Milano, Italy Pier Carlo Braga, M.D. Centro di Farmacologia Respiratoria Via Van vitelli, 32, Milano, Italy Roberto Dal Negro, M.D. Servizio di Fisiopatologia Respiratoria Ospedale di Bussolengo, Via Ospedale, Bussolengo (Verona), Italy ISBN ISBN (ebook) DOl / This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9,1965, in its current version, and a copyright free must always be paid. Violations fall under the prosecution act of the German Copyright Law. Springer-Verlag Berlin Heidelberg 1993 Softcover reprint ofthe hardcover 1 st edition 1993 The use of registered names, trademarks, etc. in the publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. 65/ Printed on acid-free paper

4 Preface Bronchial asthma is a multifactorial disease. Cooperation between pneumologists, phy&iologists, immunologists, pharmacologists, psychologists, and pediatricians is frequently needed for the complete investigation of an asthma case. This means that a physician in general practice cannot alone assess all the aspects of asthma and must frequently refer patients to a variety of specialists employing different techniques to manage this disease. In keeping with the original meaning of uvv-8p6f.lo~, asthma has long been viewed as a syndrome, as a "con-course" of several different causal and mediating factors. A correct approach to examination should clarify all of these more or less evident aspects. The aim of the present book is to provide a collection of articles detailing current knowledge on the most important techniques and methods, as this information to date has usually been scattered in papers from different cultural and scientific areas. We thus hope that this book will provide physicians with a unique source on the principal methods which can be used to analyze individual cases of asthma and a helpful reference source for better understanding the multiple pathways to the disease. LUIGI ALLEGRA PIER CARLO BRAGA ROBERTO DAL NEGRO

5 Contents Part I. Basic Aspects Definition and Classification of Asthma N. G. M. ORIE Physiology of the Airways S. DAMATO Asthma: Origin, Mechanisms, and Clinical Aspects I. ZIMENT Part II. Conditions Leading to Asthma Genetic Predisposition in Asthma C. Po MARl and P. TURCO Endocrinological Changes and Asthma G. PIATTI and S. CENTANNI Psychogenic Factors in Asthma R. BOSSI, P. BANFI, and F. BERNI Part III. Assessment of Respiratory Functions: Methodology 87 Volume, Flow, and Resistance Assessment in Asthma S. DAMATO Distributional Methods and Invasive and Noninvasive Gas Analysis in Asthma R. DAL NEGRO and L. ALLEGRA Part IV. Specific Bronchial Challenges Skin Tests and Radioimmunological Assays S. CENTANNI and G. PIATTI Allergen Administration in Bronchial Provocation Tests B. J. O. WONG and F. E. HARGREAVE

6 VIII Contents Part V. Nonspecific Bronchial Challenges Radiogas and Radioaerosol Production, Imaging, and Dosimetry in Asthmology P. GERUNDINI, R. BENTI and A. BRUNO Physical Agents in Bronchial Provocation Tests: Nebulized Hypoosmolar Aerosol L. ALLEGRA and R. DAL NEGRO Physical Agents in Bronchial Provocation Tests: Nebulized Hyperosmolar Aerosol C. M. SMITH Chemical Agents in Bronchial Provocation Tests P. MAGYAR Pharmacological Agents in Bronchial Provocation Tests A. SZCZEKLIK and E. NIZANKOWSKA Occupational Agents in Bronchial Provocation Tests L. M. FABBRI, A. P API, C. E. MAPP and A. CIACCIA Exercise and Hyperventilation Provocation Challenges S. ANDERSON, P. TESSIER, C. M. SMITH, and J. L. MALO Mediators in Bronchial Provocation Tests N. DEL BONO and L. DEL BONO Part VI. Diagnostic Use of Bronchodilators..., 345 Long- and Short-Term Reversibility Tests N. E. MOAVERO Part VII. Anatomical Structures Involved in Asthma: Methodology In Vivo Experimental Methods for Assessing Muscle Tone Involvement in Bronchial Constriction P. C. BRAGA In Vitro Experimental Methods for Assessing Tracheobronchial Smooth Muscle Contraction P. C. BRAGA Evaluation of In Vitro Data on Agents Acting on Respiratory Smooth Muscle Tone P. C. BRAGA Methods for Assessing Airway Blood Flow in Asthma A. WANNER Bronchoalveolar Lavage in Asthma S. I. RENNARD, A. A. FLOREANI, J. LINDER, A. B. THOMPSON, S. MCGRANAGHAN, and J. R. SPURZEM Subject Index

7 List of Contributors ALLEGRA, L.; Institute of Respiratory Diseases, School of Medicine, University of M;ilan, Milano, Italy ANDERSON, S.; Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia BANFI, P.; Department of Pneumology, S. Corona Hospital, Garbagnate (MI), Italy BENTI, R; Department of Nuclear Medicine, IRCCS, Ospedale Maggiore, Milano, Italy BERNI, E; Department of Pneumology, S. Corona Hospital, Garbagnate (MI) Italy BOSSI, R; Institute of Respiratory Diseases, School of Medicine, BRAGA, P. c.; Center for Respiratory Pharmacology, School of Medicine, BRUNO, A; Department of Nuclear Medicine, IRCCS, Ospedale Maggiore, Milano, Italy CENTANNI, S.; Institute of Respiratory Diseases, School of Medicine, CIACCIA, A; Institute of Infections and Respiratory Diseases, School of Medicine, University of Ferrara, Ferrara, Italy DAL NEGRO, R; Department of Lung Pathophysiology, General Hospital, Bussolengo (VR), Italy DAMATO, S.; Institute of Respiratory Diseases, School of Medicine, DEL BONO, L.; Centro per 10 Studio dell' Asma e delle Allergopatie Respiratorie, Cisanello, Pisa, Italy DEL BONO, N.; Centro per 10 Studio dell' Asma e delle Allergopatie Respiratorie, Cisanello,Pisa, Italy FABBRI, L.; Institute of Infections and RespiratoryDiseases, School of Medicine, University of Ferrara, Ferrara, Italy FLOREANI, A A; Department of Internal Medicine, Pulmonary and Critical Care, University of Nebraska, Omaha, NB, U.S.A GERUNDINI, P.; Department of Nuclear Medicine, IRCCS, Ospedale Maggiore, Milano, Italy

8 X List of Contributors HARGREAVE, F. E.; Firestone Regional Chest and Allergy Unit, St. Joseph's Hospital, Hamilton, Ontario, Canada LINDER, 1; Department of Internal Medicine, Pulmonary and Critical Care, University of Nebraska, Omaha, NB, US.A MCGRANAGHAN, S.; Department of Internal Medicine, Pulmonary and Critical Care, University of Nebraska, Omaha, NB, US.A MAGYAR, P.; Department of Pulmunology, Semmelweis Medical University, Budapest, Hungary MALo, 1 L.; Department of Chest Medicine, Hopital du Sacre-Coeur, Montreal, Canada MAPP, C. E.; Institute of Occupational Medicine, School of Medicine, University of Padova, Padova, Italy MOAVERO, N. E.; Institute of Respiratory Diseases, School of Medicine, NIZANKOWSKA, E.; Department of Medicine, Copernicus Academy of Medicine, Krak6w, Poland ORIE, N. G. M.; Department of Internal Medicine, University of Groningen, The Netherlands PAPI, A; Institute of Infections and Respiratory Diseases, Schooi of Medicine, University of Ferrara, Ferrara, Italy PIATTI, G.; Institute of Respiratory Diseases, School of Medicine, POMARI, c.; Department of Lung Pathophysiology, General Hospital, Bussolengo (VR), Italy RENNARD, S. I.; Department of Internal Medicine, Pulmonary and Critical Care, University of Nebraska, Omaha, NB, US.A SMITH, C. M.; Department of Allergy and Allied Respiratory Disorders, Guy's Hospital, London, United Kingdom SPURZEM, 1 R.; Department of Internal Medicine, Pulmonary and Critical Care, University of Nebraska, Omaha, NB, US.A SZCZEKLIK, A; Department of Medicine, Copernicus Academy of Medicine, Krak6w, Poland TESSIER, P.; Department of Chest Medicine, Hopital du Sacre-Coeur, Montreal, Canada THOMPSON, A B.; Department of Internal Medicine, Pulmonary and Critical Care, University of Nebraska, Omaha, NB, US.A TURCO, P.; Department of Lung Pathophysiology, General Hospital, Bussolengo (VR), Italy WANNER, A; Pulmonary Division, School of Medicine, University of Miami, Miami, FL, US.A WONG, B. 10.; Firestone Regional Chest and Allergy Unit, St. Joseph's Hospital, Hamilton, Ontario, Canada ZIMENT, I.; Department of Medicine, Olive View Medical Center, UCLA School of Medicine, Sylmar, CA, US.A

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