Hypertonic saline challenge in an adult epidemiological survey

Abstract

Branchial provocation teals using pharmacological agents such as methacholine or histamine are used in epidemiological studies to identify asthma despite recognition of limitations in specificity positive predictive value and availability of reagents. Hypertonic saline (4.5%) bronchial challenge (HSBC), although less sensitive than pharmacological challenges, is reportedly highly specific in diagnosing current asthma. Added advantages are that reagents are cheap, stable and recognized by participants. Thus, HSBC may offer benefits over pharmacological tests in epidemiological surveys. This paper reports on the second field survey using the test, a study of 99 adults from the timber industry in Western Australia. The test is described and critically appraised as a practical epidemiological tool for assessing asthma prevalence. At a cutoff point of 20% FEV1 fall, HSBC was positive in 8% of subjects, appeared specific far asthma, was safe, well-accepted and easy to use in the field.