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KMID : 0369319940140020175
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Allergy
1994 Volume.14 No. 2 p.175 ~ p.183
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Chronic Cough in Children : Positive Rates and Provocated symptoms of Methacholine Bronchial Provocation Test
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이수영
정병주/김희수/김동수/김규언/이기영
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Abstract
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Chronic cough is an important, relatively frequent, and sometimes frustrating problem that can be a sole presenting manifestation of asthma in adults and children. To evaluate the positive rates and provocated symptoms in patients with chronic
cough, we
underwent the methacholine bronchial provocation test (MBPT) in 34 children(6-13 years old) who suffered from chronic cough. We compared the results of MBPT and allergic skin tests(by scratch method) between the following two groups: Group I
included 14
children with chronic, nocturnal, dry cough combined with wheezing and Group II, 20 children with chronic cough but without wheezing.
Positive rate of MBPT in Group I and Group II were 86%(12 out of 14) 65%(13 out of 20), respectively. Geometric mean of provocative concentration of the methacholine causing a 20 percent fall of PEFR(PC20) in 25 methacholine provocation test
positive
sujects were 1.4mg/ml(Group I) and 3.09mg/ml(Group II) (p=0.167). Twenty four out of 34 children showed positive skin reactions to 1 or more common allergens, among whom 21(88%) children had positive results of MBPT. Among 10 children with
negative
skin
reactions, only 4()40%) children had positive results of MBPT.
During MBPT, in Group I, 36.4% of patients had complained cough and 90% of patients, wheezing whereas in Group II, 66.7% and 58.3% complained respectively. But there were no significant differences in the thresholds of PEFR causing cough and
wheezing,
maximal percent fall of PEFR and bronchodilator effect between Group I and Group II.
In conclusion, most cases of the children suffering from chronic cough with frequent wheezing can be easily diagnosed as asthma by the history taking only, but cases of chronic cough without history of wheezing need further evaluation with MBPR
or
other
diagnostic modalities such as exercise loading test, cold air inhalation test and bronchodilator test to identity the reversible airway obstraction.
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