Symptoms, physical findings and bronchial hypersensitivity in patients with bronchial asthma and normal spirometry

Abstract

Background/Aim. The diagnosis of bronchial asthma, a chronic inflammatory disease of the respiratory tract, is made on the basis of anamnesis, pathologic auscultatory findings of the lungs, lung function disturbances, skin tests, as well as the basic indices of immunologic condition in bronchial trunk. The aim of the study was to find out correlation of objective indices of the disease and than relation with the symptoms in the patients with bronchial asthma. Methods. The study included 60 young male non smokers with long lasting symptoms of bronchial asthma including shortness of breath, wheezing, hard breathing, nonproductive or productive cough, weakness and night hard breathing. There were no symptoms of respiratory infection over the past two months and lung radiography and spirometry were normal. Based on the results of nonspecific bronchoprovocative test two groups of the patients were formed, group I (n = 30) with positive histamine test (average value of the inhaled histamine concentration with FEV1 drop by 20% in regard with the initial value (PC20) = 2.99 ? 0.51 mg/ml of histamine) and group II (n = 30) with negative histamine test (PC20(a) = 14.58 ? 6.34 mg/ml of histamine). Results. The obtained spirometry results revealed a statistically significant difference in values of FEV1 between groups: I group - FEV1 = 93.2%; II group - FEV1 = 101.8%; (p < 0.05, Wilcoxon test), although all the FEV1 values were normal. Regarding the presence of the most common symptoms there was not statistically significant difference between the groups (p > 0. 05, chisquare test). Pathologic auscultatory lung findings were found in 73.4% of the patients in the group I and 27.5% of the patients in the group II. There was statistically significant difference (p < 0.05, chi-squared test). A positive correlation between the degree of hypersensitivity and lung physical findings was confirmed (p < 0.05 Spearman's rho), but there was no correlation with FEV1 values. Conclusion. There is a correlation with lung pathologic physical findings, lower values of FEV1 (in a range of normal values) and the degree of nonspecific bronchial sensitivity as objective indices of activity of bronchial asthma. There is no correlation of these parameters with patient's symptoms as subjective indices of bronchial asthma.Uvod/Cilj. Dijagnoza bronhijalne astme, hronicnog inflamatornog oboljenja disajnih puteva, postavlja se na osnovu anamneze, patoloskog auskultatornog nalaza nad plucima, poremecaja plucne funkcije, koznih testova i osnovnih pokazatelja imunoloskog stanja u bronhijalnom stablu. Cilj rada bio je da se kod obolelih od bronhijalne astme sa normalnim spirometrijskim nalazom proceni medjusobna povezanost objektivnih parametara bolesti, kao i njihova veza sa simptomima oboljenja. Metode. U studiju su bili ukljuceni bolesnici nepusaci (60 mladih muskaraca), sa visegodisnjim simptomima bronhijalne astme kao sto su gusenje, sviranje u grudima, otezano disanje, suv ili produktivan kasalj, zamaranje i nocno gusenje. Nije bilo simptoma ni znakova respiratorne infekcije tokom prethodna dva meseca i radiografija pluca i spirometrijski nalaz bili su normalni. Na osnovu rezultata nespecificnog bronhoprovokacijskog testa formirane su dve grupe bolesnika: grupa I (30 bolesnika) sa pozitivnim histaminskim testom, prosecna vrednost koncentracije udahnutog histamina sa padom FEV1 za 20% u odnosu na pocetnu vrednost (PC20) bila 2,99 ? 0,51 mg/ml i grupa II (30 bolesnika) sa negativnim histaminskim testom (PC20(a) = 14,58 ? 6,34 mg/ml). Rezultati. Analizom rezultata spirometrije utvrdjeno je da je postojala statisticki znacajna razlika vrednosti FEV1 medju grupama: grupa I - FEV1 = 93,2%; grupa II - FEV1 = 101,8%; (p < 0,05, Wilcoxon's test), iako su sve vrednosti FEV1 bile u podrucju referentnih. U zastupljenosti najcescih simptoma nije bilo znacajne razlike medju grupama (p > 0,05, hi-kvadrat test). Patoloski auskultatorni nalaz nad plucima postojao je kod 73,4% bolesnika u grupi I, a u grupi II kod 27,5% bolesnika (p < 0,05, hi-kvadrat test). Potvrdjena je pozitivna korelacija izmedju stepena hipersenzitivnosti i fizickog nalaza na plucima (p < 0,05, Spearman-ov koeficijent korelacije) dok nije bilo korelacije sa vrednostima FEV1. Zakljucak: Postoji povezanost patoloskog auskultatornog nalaza nad plucima, nizih vrednosti FEV1 (u granicama referentnih vrednosti) i stepena nespecificne bronhijalne hipersenzitivnosti kao objektivnih pokazatelja aktivnosti bronhijalne astme. Nema korelacije tih parametara sa ispoljenim simptomima kao subjektivnim pokazateljima aktivnosti bronhijalne astme.