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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng245er8-lrg.png" alt="Cover of Evidence reviews for bronchial challenge with histamine and methacholine for the diagnosis of asthma" /></a><div class="icnblk_cntnt"><h1 id="_NBK611961_"><span itemprop="name">Evidence reviews for bronchial challenge with histamine and methacholine for the diagnosis of asthma</span></h1><div class="subtitle">Asthma: diagnosis, monitoring and chronic asthma management (update)</div><p><b>Evidence review H</b></p><p><i>NICE Guideline, No. 245</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2024 Nov</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-6621-9</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © BTS, NICE and SIGN.</div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="niceng245er8.s1"><h2 id="_niceng245er8_s1_">1. Histamine and methacholine</h2><div id="niceng245er8.s1.1"><h3>1.1. Review question</h3><p>In people under investigation for asthma, what is the diagnostic test accuracy and clinical and cost (direct) effectiveness with histamine and methacholine?</p><div id="niceng245er8.s1.1.1"><h4>1.1.1. Introduction</h4><p>Asthma can be a difficult condition to diagnose, and it is not clear which tests are most useful in supporting a diagnosis. Histamine and methacholine both bind with receptors on airway smooth muscle and stimulate muscle contraction, and therefore airway narrowing. They are used in bronchial challenge tests whereby they are given in increasing doses via a nebuliser until a certain amount of narrowing has occurred (determined by spirometry) or the maximum dose has been given. Typically, people with asthma have an exaggerated responsive (bronchial hyperresponsiveness) to these agents compared to healthy people. Histamine and methacholine are therefore potentially useful in establishing a diagnosis of asthma and this evidence review was carried out to determine their clinical and cost-effectiveness as diagnostic tests.</p></div><div id="niceng245er8.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><p>For full details see the review protocol in <a href="#niceng245er8.appa">Appendix A</a>.</p><p>No test-and-treat evidence was found so only the diagnostic accuracy evidence was reported.</p></div><div id="niceng245er8.s1.1.3"><h4>1.1.3. Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng245er8.appa">appendix A</a> and the methods document.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng245er8.s1.1.4"><h4>1.1.4. Diagnostic evidence</h4><div id="niceng245er8.s1.1.4.1"><h5>1.1.4.1. Included studies</h5><p>Eight cross-sectional diagnostic accuracy studies were included in the review (<a class="bk_pop" href="#niceng245er8.s1.ref1">Alberts, et al., 1987</a>, <a class="bk_pop" href="#niceng245er8.s1.ref2">Anderson, et al., 2009</a>, <a class="bk_pop" href="#niceng245er8.s1.ref3">Hedman, et al., 1998</a>, <a class="bk_pop" href="#niceng245er8.s1.ref5">Kowal, et al., 2009</a>, <a class="bk_pop" href="#niceng245er8.s1.ref6">Louis, et al., 2020</a>, <a class="bk_pop" href="#niceng245er8.s1.ref9">Popovic-Grle, et al., 2002</a>, <a class="bk_pop" href="#niceng245er8.s1.ref10">Porpodis, et al., 2017</a>, <a class="bk_pop" href="#niceng245er8.s1.ref11">Zaczeniuk, et al., 2015</a>) these are summarised in <a href="/books/NBK611961/table/niceng245er8.tab2/?report=objectonly" target="object" rid-ob="figobniceng245er8tab2">Table 2</a> below. Evidence from these studies is summarised in the clinical evidence summary below in <a href="/books/NBK611961/table/niceng245er8.tab3/?report=objectonly" target="object" rid-ob="figobniceng245er8tab3">Table 3</a> and references in <a href="#niceng245er8.s1.rl.r1">1.3</a> References . The assessment of the evidence quality was conducted with emphasis on test sensitivity and specificity as this was identified by the committee as the primary measure in guiding decision-making. The committee set clinical decision thresholds as sensitivity: upper= 90% and lower= 10%, specificity: upper= 80% and lower= 50%. Values above the upper threshold indicated a test would be recommended and values below the lower threshold indicated a test is of no clinical use.</p><p>See also the study selection flow chart in <a href="#niceng245er8.appc">Appendix C</a>, sensitivity and specificity forest plots in <a href="#niceng245er8.appe">Appendix E</a>, and study evidence tables in <a href="#niceng245er8.appd">Appendix D</a>.</p></div><div id="niceng245er8.s1.1.4.2"><h5>1.1.4.2. Excluded studies</h5><p>Two studies included in the previous NICE guidance on this topic were excluded from this review. One study was excluded due to containing a population not relevant to the current review protocol, namely due to the inclusion of participants already diagnosed with asthma at study entry. The other study was excluded due to including participants receiving inhaled corticosteroids and not including an adequate washout period prior to the study. See the excluded studies list in <a href="#niceng245er8.apph">Appendix H</a>.</p></div></div><div id="niceng245er8.s1.1.5"><h4>1.1.5. Summary of studies included in the diagnostic evidence</h4><p>See <a href="#niceng245er8.appd">Appendix D</a> for full evidence tables.</p></div><div id="niceng245er8.s1.1.6"><h4>1.1.6. Summary of the diagnostic evidence</h4><p>The assessment of the evidence quality was conducted with emphasis on test sensitivity and specificity as this was identified by the committee as the primary measure in guiding decision-making. The committee set clinical decision thresholds as sensitivity: upper= 90% and lower= 10%, specificity: upper= 80% and lower= 50%. Values above the upper threshold indicated a test would be recommended and values below the lower threshold indicated a test is of no clinical use.</p></div><div id="niceng245er8.s1.1.7"><h4>1.1.7. Economic evidence</h4><div id="niceng245er8.s1.1.7.1"><h5>1.1.7.1. Included studies</h5><p>No health economic studies were included.</p></div><div id="niceng245er8.s1.1.7.2"><h5>1.1.7.2. Excluded studies</h5><p>One economic study relating to this review question was identified but was excluded due to limited applicability(<a class="bk_pop" href="#niceng245er8.s1.ref4">Kennedy, et al., 2007</a>). This is listed in <a href="#niceng245er8.apph">Appendix H</a>, with reasons for exclusion given.</p><p>See also the health economic study selection flow chart in <a href="#niceng245er8.appf">Appendix F</a>.</p></div></div><div id="niceng245er8.s1.1.8"><h4>1.1.8. Summary of included economic evidence</h4><p>None.</p></div><div id="niceng245er8.s1.1.9"><h4>1.1.9. Economic model</h4><p>A health economic model was conducted focusing on sequences and combinations of diagnostic tests. This is reported in Evidence review 1.11.</p></div><div id="niceng245er8.s1.1.10"><h4>1.1.10. Unit costs</h4><p>Relevant unit costs are provided below to aid consideration of cost effectiveness.</p></div><div id="niceng245er8.s1.1.11"><h4>1.1.11. Evidence statements</h4><div id="niceng245er8.s1.1.11.1"><h5>Economic</h5><ul><li class="half_rhythm"><div>No relevant economic evaluations were identified.</div></li></ul></div></div></div><div id="niceng245er8.s1.2"><h3>1.2. The committee’s discussion and interpretation of the evidence</h3><div id="niceng245er8.s1.2.1"><h4>1.2.1. The outcomes that matter most</h4><div id="niceng245er8.s1.2.1.1"><h5>Test and treat studies</h5><p>The outcomes considered for this review were: severe asthma exacerbations, mortality, quality of life, asthma control, hospital admissions, reliever/rescue medication use, lung function (change in FEV1 or morning PEF – average over at least 7 days for morning PEF), adverse events (linear growth, pneumonia frequency, adrenal insufficiency, bone mineral density), inflammatory markers; exhaled nitric oxide (continuous outcome at ≥8 weeks). For the purpose of decision making, all outcomes were considered equally important and were therefore rated as critical by the committee. No relevant evidence was identified for any of the outcomes.</p></div><div id="niceng245er8.s1.2.1.2"><h5>Diagnostic accuracy</h5><p>The committee considered the diagnostic measures of sensitivity and specificity of the index test for diagnosing asthma as well as the positive and negative predictive values where these were reported by the studies. Clinical decision thresholds were set by the committee as sensitivity/specificity 0.9 and 0.8 above which a test would be recommended and 0.1 and 0.5 below which a test is of no clinical use. The committee were interested in establishing whether there was an optimal cut-off value of bronchial challenge testing with histamine or methacholine with sufficiently high sensitivity and specificity to be useful in making a diagnosis of asthma, but also in whether there are separate cut-off values which could usefully help either rule in or rule out an asthma diagnosis.</p></div></div><div id="niceng245er8.s1.2.2"><h4>1.2.2. The quality of the evidence</h4><div id="niceng245er8.s1.2.2.1"><h5>Test and treat studies</h5><p>No relevant clinical studies were identified comparing the clinical effectiveness of diagnosis of asthma based on bronchial challenge with histamine or methacholine, in terms of the clinical outcomes examined.</p></div><div id="niceng245er8.s1.2.2.2"><h5>Diagnostic accuracy</h5><p>Eight cross-sectional studies were included in this review, seven in adults and one in children/young people. In the adolescent/adult studies, two studies included only non-smoking participants whilst the other five included a mixture of smoking and non-smoking participants or did not report smoking status. Seven studies examined the diagnostic accuracy of bronchial challenge testing with methacholine and a single study examined the diagnostic accuracy of bronchial challenge testing with histamine. A variety of cut-off values were applied in the included studies. Six studies expressed cut-offs as provocative concentration, with two studies applying a cut-off of PC20 FEV<sub>1</sub> ≤8 mg/mL (one with histamine and one with methacholine) and four studies using PC20 FEV<sub>1</sub> ≤16 mg/mL methacholine. Two studies expressed cut-offs as provocative dose of methacholine, with one study using a PD20 FEV<sub>1</sub> of ≤0.72 mg and another study using a PD20 FEV<sub>1</sub> ≤6900 μg.</p><p>Evidence ranged from moderate to very low quality. All evidence was downgraded by at least one increment due to risk of bias, typically due to unclear participants recruitment methods, unclear blinding on index test and reference standard results and less frequently due to missing participants in the reported data. Half of the evidence was downgraded due to indirectness, typically due to not reporting the ICS use of participants, mixing smoking and non-smoking participants or due to reference standard indirectness where it was unclear if asthma was diagnosed using protocol-specified criteria.</p></div></div><div id="niceng245er8.s1.2.3"><h4>1.2.3. Benefits and harms</h4><div id="niceng245er8.s1.2.3.1"><h5>Children and young people</h5><p>Very low-quality evidence from one study reported the accuracy of methacholine challenge testing using a cut-off of PD20 FEV<sub>1</sub> ≤0.72 mg compared to a clinician diagnosis with bronchodilator reversibility testing as an objective test. This evidence showed both a high sensitivity and specificity of 0.90 and 0.82, respectively, meeting the decision-making threshold for both outcomes. However, this evidence was at risk of bias due to an unclear recruitment method, limited detail over blinding of test results and missing outcome data from 10% of participants. Furthermore, this evidence was downgraded due to indirectness resulting from the inclusion of both children/young people and adolescent/adults, with an age range of 10-18 years being reported. Finally, imprecision was seen in both estimates, partially reflecting the small number of participants contributing to this evidence (n=90). Despite these concerns, the committee agreed that the evidence showed that bronchial challenge tests could be carried out by children and are useful in supporting a diagnosis of asthma.</p></div><div id="niceng245er8.s1.2.3.2"><h5>Non-smoking adults</h5><p>Very low-quality evidence from one study reported the accuracy of methacholine bronchial challenge testing using a cut-off of PC20 FEV<sub>1</sub> ≤16 mg/mL compared to a clinician diagnosis with exercise challenge, skin prick and bronchodilator reversibility tests. This evidence reported a sensitivity of 0.51 and a specificity of 0.75, neither of which met the threshold for decision-making.</p><p>Very low-quality evidence from one study reported the accuracy of histamine bronchial challenge testing using a cut-off of PC20 FEV<sub>1</sub> ≤8 mg/mL compared to diagnosis with peak flow variability or bronchodilator reversibility tests. This evidence reported a sensitivity of 0.93 and specificity of 1.00, meeting both thresholds for decision-making. However, the committee acknowledged the limitations of the evidence, namely due to risk of bias arising from an unclear recruitment method and unclear blinding of test results, and indirectness due to a lack of clarity over a clinician decision in the reference standard asthma diagnosis.</p></div><div id="niceng245er8.s1.2.3.3"><h5>Adults with mixed or unreported smoking status</h5><p>Very low-quality evidence from two studies reported the accuracy of methacholine bronchial challenge testing using a cut-off of PC20 FEV<sub>1</sub> ≤8 mg/mL. The first used a clinician diagnosis with bronchodilator reversibility testing as the reference standard, reporting both a high sensitivity of 0.97 and specificity of 0.83, both of which met the decision-making threshold. This evidence was at risk of bias due to unclear blinding of test results and was downgraded due to indirectness as a result of mixing smoking and non-smoking participants, and not reporting pre-study ICS use. The second study used a reference diagnosis with bronchodilator reversibility alone, reporting a high sensitivity of 0.82 and a low specificity 0.30, neither of which met the decision-making threshold. This evidence was at risk of bias due to an unclear recruitment method and was downgraded due to indirectness resulting from mixing smoking and non-smoking participants and using a reference standard that didn’t include a clinician decision in the final diagnosis. Given the differences between the estimates of specificity reported by the individual studies, both pieces of evidence were further downgraded due to inconsistency.</p><p>Very low-quality evidence from three studies reported the accuracy of methacholine bronchial challenge testing using a cut-off of PC20 FEV<sub>1</sub> ≤16 mg/mL. After meta-analysis, the pooled estimate of sensitivity from this evidence was 0.72, and specificity was 0.58, neither of which met the decision-making threshold. This evidence was at risk of bias arising from unclear recruitment methods, unclear blinding procedures and missing data. Additionally, indirectness was present due to the evidence containing a mixture of smoking and non-smoking participants, pre-study ICS status not being reported, and the absence of a clinician decision in the final asthma diagnosis. Furthermore, there was significant inconsistency seen in the estimates of both sensitivity and specificity across the included studies, leading to further downgrading.</p><p>Moderate-low-quality evidence from one study reported the diagnostic accuracy of methacholine bronchial challenge testing using a cut-off of PD20 FEV<sub>1</sub> ≤6900 μg, showing a moderate sensitivity of 0.77 and high specificity of 0.82. This evidence was downgraded for indirectness due to containing a mixture of smoking and non-smoking participants, with the specificity estimate being further downgraded due to the 95%CI overlapping the upper decision-making threshold.</p><p>The results overall are inconsistent, probably because of a combination of differences in study populations, reference standards and challenge test protocols. The cut-offs chosen to define asthma also varied which will affect the sensitivity and specificity results. Nonetheless, challenge tests generally showed better accuracy than other tests, and the committee noted that with a sensible cut-off value they can produce good sensitivity without sacrificing specificity too much, suggesting that they could be useful as a rule-out test for asthma.</p></div></div><div id="niceng245er8.s1.2.4"><h4>1.2.4. Cost effectiveness and resource use</h4><p>No relevant published health economic analyses were identified for this review question. The cost of a histamine or methacholine challenge test was presented to aid committee consideration of cost effectiveness. The cost was estimated to be £179.49 as the test is provided only in secondary care. The committee agreed that bronchial challenge stands out as the most accurate test for diagnosing asthma but acknowledged that its high cost, the low availability of methacholine and extended waiting list in secondary care made this test unsuitable for widespread use.</p><p>The committee considered bronchial challenge test with methacholine alongside or in combination with a variety of tests for asthma within a diagnostic algorithm in adults and children (see evidence review 1.11). The economic analysis found bronchial challenge test cost-effective when included in the final step of both adults and children diagnostic pathway. The committee noticed that this test may not be widely available across the country and, therefore, should be reserved for fewer people with complex clinical history who arrived at the end of the pathway with an uncertain diagnosis. Therefore, the committee recommended to include bronchial challenge test in the final stage of both diagnostic algorithms.</p></div><div id="niceng245er8.s1.2.5"><h4>1.2.5. Other factors the committee took into account</h4><p>One factor that was considered when discussing the evidence was the risk of adverse side effects occurring during bronchial challenge tests. This was initially raised as a point of concern by the lay members of the committee due to theoretical danger of deliberately restricting the airways. However, this concern was alleviated by the clinicians on the committee. It was explained that bronchial challenge tests only aim to achieve a reduction in FEV<sub>1</sub> of 20%, which in most individuals is not an uncomfortable level of bronchoconstriction. In very few cases a fall in FEV<sub>1</sub> of up to 40% may occur, but bronchial challenge tests are always followed by a rapid-acting bronchodilator to restore the functionality of the airway, thus limiting any discomfort experienced. Furthermore, bronchial challenge tests are conducted in secondary care where specialist attention and facilities are available should any adverse events occur. Given the low likelihood of adverse events, combined with the safe testing environment, the committee agreed that the benefits of bronchial challenge testing with methacholine strongly outweighed the risks. However, histamine is known to have other side effects, such as flushing and headaches. With these side effects in mind, the committee agreed that methacholine challenge testing was a more suitable bronchial challenge test for the diagnosis of asthma.</p><p>A second consideration was the limited availability of methacholine. Clinicians on the committee highlighted that issues with acquiring methacholine had been experienced in the past due to supplier issues. Historically, methacholine has been supplied in a concentrated form that requires specific preparation into a solution before it able to be used. This adds a layer of complexity to the testing procedure for the centre conducting tests. Furthermore, the amount of time that prepared methacholine solution can be stored for is limited to a number of days, resulting in wastage if a sufficient volume of tests are not conducted in a set time period. However, it was noted that with the introduction of specialised diagnostic hubs this wastage is less likely to occur as more tests per day will be conducted. Despite these considerations the committee still agreed that methacholine challenge testing demonstrated very good diagnostic accuracy and should be included in the diagnostic pathway.</p><p>The committee also noted that challenge tests require repeated spirometry measurements and people who find spirometry difficult may not produce reliable results. This is a minority of people but will limit the application of the test to some degree.</p></div><div id="niceng245er8.s1.2.6"><h4>1.2.6. Recommendations supported by this evidence review</h4><p>Recommendations 1.2.4 and 1.2.9.</p></div></div><div id="niceng245er8.s1.rl.r1"><h3>1.3. References</h3><ul class="simple-list"><li class="half_rhythm"><div class="bk_ref" id="niceng245er8.s1.ref1">Alberts
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WM, Goldman
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AL (1987) Clinical use of methacholine bronchial challenge testing
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<em>Southern Medical Journal</em>
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80 (7): 827–830.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/3603103" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3603103</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng245er8.s1.ref2">Anderson
|
||
SD, Charlton
|
||
B, Weiler
|
||
JM, et al. (2009) Comparison of mannitol and methacholine to predict exercise-induced bronchoconstriction and a clinical diagnosis of asthma
|
||
<em>Respiratory Research</em>
|
||
10: 4. [<a href="/pmc/articles/PMC2644668/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2644668</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19161635" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19161635</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng245er8.s1.ref3">Hedman
|
||
J, Poussa
|
||
T, Nieminen
|
||
MM (1998) A rapid dosimetric methacholine challenge in asthma diagnostics: a clinical study of 230 patients with dyspnoea, wheezing or a cough of unknown cause
|
||
<em>Respiratory Medicine</em>
|
||
92 (1): 32–39.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/9519222" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9519222</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng245er8.s1.ref4">Kennedy
|
||
WA, Girard
|
||
F, Chaboillez
|
||
S, et al. (2007) Cost-effectiveness of various diagnostic approaches for occupational asthma
|
||
<em>Canadian Respiratory Journal</em>
|
||
14 (5): 276–280.
|
||
[<a href="/pmc/articles/PMC2676393/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2676393</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/17703242" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17703242</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng245er8.s1.ref5">Kowal
|
||
K, Bodzenta-Lukaszyk
|
||
A, Zukowski
|
||
S (2009) Exhaled nitric oxide in evaluation of young adults with chronic cough
|
||
<em>Journal of Asthma</em>
|
||
46 (7): 692–698. [<a href="https://pubmed.ncbi.nlm.nih.gov/19728207" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19728207</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng245er8.s1.ref6">Louis
|
||
R, Bougard
|
||
N, Guissard
|
||
F, et al. (2020) Bronchodilation Test with Inhaled Salbutamol Versus Bronchial Methacholine Challenge to Make an Asthma Diagnosis: Do They Provide the Same Information?
|
||
<em>The Journal of Allergy & Clinical Immunology in Practice</em>
|
||
8 (2): 618–625.e618.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/31541767" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31541767</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng245er8.s1.ref7">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. . London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>.nice.org.uk<wbr style="display:inline-block"></wbr>/article/PMG20/chapter<wbr style="display:inline-block"></wbr>/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng245er8.s1.ref8">NHS England. 2021/22 National Cost Collection data. 2022. Available from: <a href="https://www.england.nhs.uk/costing-in-the-nhs/national-cost-collection/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>.england.nhs<wbr style="display:inline-block"></wbr>.uk/costing-in-the-nhs<wbr style="display:inline-block"></wbr>/national-cost-collection/</a> Last accessed: 26/02/2024.</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng245er8.s1.ref9">Popovic-Grle
|
||
S, Mehuli
|
||
M, Pavici
|
||
F, et al. (2002) Clinical validation of bronchial hyperresponsiveness, allergy tests and lung function in the diagnosis of asthma in persons with dyspnea
|
||
<em>Collegium Antropologicum</em>
|
||
26suppl: 119–127. [<a href="https://pubmed.ncbi.nlm.nih.gov/12674843" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12674843</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng245er8.s1.ref10">Porpodis
|
||
K, Domvri
|
||
K, Kontakiotis
|
||
T, et al. (2017) Comparison of diagnostic validity of mannitol and methacholine challenges and relationship to clinical status and airway inflammation in steroid-naive asthmatic patients
|
||
<em>The Journal of asthma : official journal of the Association for the Care of Asthma</em>
|
||
54 (5): 520–529.
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/27686218" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27686218</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="niceng245er8.s1.ref11">Zaczeniuk
|
||
M, Woicka-Kolejwa
|
||
K, Stelmach
|
||
W, et al. (2015) Methacholine challenge testing is superior to the exercise challenge for detecting asthma in children
|
||
<em>Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology</em>
|
||
115 (6): 481–484. [<a href="https://pubmed.ncbi.nlm.nih.gov/26602490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26602490</span></a>]</div></li></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng245er8.appa"><h3>Appendix A. Review protocols</h3><p id="niceng245er8.appa.et1"><a href="/books/NBK611961/bin/niceng245er8-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for diagnostic test accuracy and clinical and cost-effectiveness of histamine and methacholine challenge tests</a><span class="small"> (PDF, 250K)</span></p><p id="niceng245er8.appa.et2"><a href="/books/NBK611961/bin/niceng245er8-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Health economic review protocol</a><span class="small"> (PDF, 137K)</span></p></div><div id="niceng245er8.appb"><h3>Appendix B. Literature search strategies</h3><p>In people under investigation for asthma, what is the diagnostic test accuracy and clinical and cost-effectiveness of bronchial challenge testing with histamine and methacholine?</p><p id="niceng245er8.appb.et1"><a href="/books/NBK611961/bin/niceng245er8-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Clinical search literature search strategy</a><span class="small"> (PDF, 199K)</span></p><p id="niceng245er8.appb.et2"><a href="/books/NBK611961/bin/niceng245er8-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Health economic literature search strategy</a><span class="small"> (PDF, 173K)</span></p></div><div id="niceng245er8.appc"><h3>Appendix C. Diagnostic evidence study selection</h3><p id="niceng245er8.appc.et1"><a href="/books/NBK611961/bin/niceng245er8-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 1. Flow chart of clinical study selection for the review of diagnostic test accuracy of histamine and methacholine challenge tests</a><span class="small"> (PDF, 100K)</span></p></div><div id="niceng245er8.appd"><h3>Appendix D. Diagnostic evidence</h3><p id="niceng245er8.appd.et1"><a href="/books/NBK611961/bin/niceng245er8-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (263K)</span></p></div><div id="niceng245er8.appe"><h3>Appendix E. Forest plots</h3><p id="niceng245er8.appe.et1"><a href="/books/NBK611961/bin/niceng245er8-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (132K)</span></p></div><div id="niceng245er8.appf"><h3>Appendix F. Economic evidence study selection</h3><p id="niceng245er8.appf.et1"><a href="/books/NBK611961/bin/niceng245er8-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 8. Flow chart of health economic study selection for the guideline</a><span class="small"> (PDF, 151K)</span></p></div><div id="niceng245er8.appg"><h3>Appendix G. Economic evidence tables</h3><p>None.</p></div><div id="niceng245er8.apph"><h3>Appendix H. Excluded studies</h3><div id="niceng245er8.apph.s1"><h4>Clinical studies</h4><div id="niceng245er8.apph.tab1" class="table"><h3><span class="label">Table 10</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK611961/table/niceng245er8.apph.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er8.apph.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Code [Reason]</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Abramson, Michael J; Puy, Robert M; Weiner, John M (2010) Injection allergen immunotherapy for asthma. The Cochrane database of systematic reviews: cd001186 [<a href="https://pubmed.ncbi.nlm.nih.gov/10796617" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10796617</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Study design not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Systematic review including intervention studies</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Alberts, W M; Goldman, A L; Leaverton, P E (1992) Bronchodilator testing “confidence intervals” based on the level of bronchial responsiveness. Chest
|
||
102(3): 737–41
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/1516395" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1516395</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Full text paper not available</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Albornoz, C; Calvo, M; Marin, F (1995) Correlation between the clinical classification of bronchial asthma severity and the methacholine test in children. Journal of investigational allergology & clinical immunology
|
||
5(6): 322–4
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/8653219" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8653219</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants diagnosed with asthma prior to study entry</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Amakye, Daniel O, Davis, Beth E, Martin, Alexandra L
|
||
et al. (2013) Refractoriness to inhaled mannitol 3 hours after allergen challenge. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
|
||
111(3): 182–4 [<a href="https://pubmed.ncbi.nlm.nih.gov/23987192" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23987192</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants diagnosed with asthma prior to study entry</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Amayasu, H, Yoshida, S, Ebana, S
|
||
et al. (2000) Clarithromycin suppresses bronchial hyperresponsiveness associated with eosinophilic inflammation in patients with asthma. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
|
||
84(6): 594–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/10875487" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10875487</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Study design not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Intervention study, not a diagnostic accuracy study</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Avital, A, Springer, C, Bar-Yishay, E
|
||
et al. (1995) Adenosine, methacholine, and exercise challenges in children with asthma or paediatric chronic obstructive pulmonary disease. Thorax
|
||
50(5): 511–6
|
||
[<a href="/pmc/articles/PMC1021220/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1021220</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/7597663" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7597663</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants diagnosed with asthma at study entry</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Ayala, L E and Ahmed, T (1989) Is there loss of protective muscarinic receptor mechanism in asthma?. Chest
|
||
96(6): 1285–91
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/2531065" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2531065</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Index test does not match review protocol</p>
|
||
<p>
|
||
<i>Methacholine using PD50 not PD20; population not matching protocol: part was not suspected of asthma</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Bacci, E, Di Franco, A, Cianchetti, S
|
||
et al. (1995) Bronchial hyperresponsiveness to hypertonic saline, but not to methacholine, predicts the presence of eosinophils in induced sputum from asthmatic patients. European respiratory journal - supplement
|
||
8(suppl19): 472s
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Backer, V and Ulrik, C S (1992) Bronchial responsiveness to exercise in a random sample of 494 children and adolescents from Copenhagen. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
|
||
22(8): 741–7
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/1525692" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1525692</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants not presenting with respiratory symptoms</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Bakirtas, Arzu and Turktas, Ipek (2007) Methacholine and adenosine 5’-monophosphate challenges in preschool children with cough-variant and classic asthma. Pediatric pulmonology
|
||
42(10): 973–9
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/17722054" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17722054</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol <i>children under the age of 5 with known asthma</i></p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Basir, R, Lehrman, S G, De Lorenzo, L J
|
||
et al. (1995) Lack of significant bronchial reactivity to inhaled normal saline in subjects with a positive methacholine challenge test. The Journal of asthma : official journal of the Association for the Care of Asthma
|
||
32(1): 63–7
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/7844091" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7844091</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>No reference standard involved</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Bruschi, C, Cerveri, I, Zoia, M C
|
||
et al. (1989) Bronchial responsiveness to inhaled methacholine in epidemiological studies: comparison of different indices. The European respiratory journal
|
||
2(7): 630–6
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/2776868" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2776868</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants not presenting with respiratory symptoms</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Caussade, S, Castro-Rodriguez, J A, Contreras, S
|
||
et al. (2015) Methacholine challenge test by wheezing and oxygen saturation in preschool children with asthma. Allergologia et immunopathologia
|
||
43(2): 174–9
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/24948183" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24948183</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Reference standard does not include an objective test - symptoms and response to treatment were used as pre-study diagnostic criteria</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Chenuel, B. (2020) A negative methacholine test rules out the diagnosis of asthma. Cons. Revue Francaise d’Allergologie
|
||
60(4): 290–291
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Choi, I.S., Lee, S., Kim, D.-H.
|
||
et al. (2007) Airways are more reactive to histamine than to methacholine in patients with mild airway hyperresponsiveness, regardless of atopy. Korean Journal of Internal Medicine
|
||
22(3): 164–170
|
||
[<a href="/pmc/articles/PMC2687687/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2687687</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/17939333" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17939333</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants diagnosed with asthma at study entry</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Choi, Inseon S, Hong, Seo-Na, Lee, Yeon-Kyung
|
||
et al. (2003) Asthmatic airway inflammation is more closely related to airway hyperresponsiveness to hypertonic saline than to methacholine. The Korean journal of internal medicine
|
||
18(2): 83–8
|
||
[<a href="/pmc/articles/PMC4531613/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4531613</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/12872444" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12872444</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Response to treatment used as reference standard</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Choi, Sun Hee, Kim, Do Kyun, Yoo, Young
|
||
et al. (2007) Comparison of deltaFVC between patients with allergic rhinitis with airway hypersensitivity and patients with mild asthma. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
|
||
98(2): 128–33 [<a href="https://pubmed.ncbi.nlm.nih.gov/17304878" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17304878</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants diagnosed with asthma prior to study entry</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Cockcroft, D W, Marciniuk, D D, Hurst, T S
|
||
et al. (2001) Methacholine challenge: test-shortening procedures. Chest
|
||
120(6): 1857–60
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/11742913" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11742913</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Study design not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Not a diagnostic accuracy study</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Cockcroft, D W, Murdock, K Y, Berscheid, B A
|
||
et al. (1992) Sensitivity and specificity of histamine PC20 determination in a random selection of young college students. The Journal of allergy and clinical immunology
|
||
89(1pt1): 23–30
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/1730837" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1730837</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants not presenting with respiratory symptoms</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Cockcroft, Donald W and Davis, Beth E (2006) The bronchoprotective effect of inhaling methacholine by using total lung capacity inspirations has a marked influence on the interpretation of the test result. The Journal of allergy and clinical immunology
|
||
117(6): 1244–8
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/16750982" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16750982</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Review article but not a systematic review</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Cockcroft, Donald W; Davis, Beth E; Blais, Christianne M (2020) Comparison of methacholine and mannitol challenges: importance of method of methacholine inhalation. Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology
|
||
16: 14
|
||
[<a href="/pmc/articles/PMC7014722/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7014722</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32082392" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32082392</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants diagnosed with asthma at study entry</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
de Jong, Carmen C M, Pedersen, Eva S L, Mozun, Rebeca
|
||
et al. (2019) Diagnosis of asthma in children: the contribution of a detailed history and test results. The European respiratory journal
|
||
54(6) [<a href="https://pubmed.ncbi.nlm.nih.gov/31515409" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31515409</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- ICS washout period not appropriate</p>
|
||
<p>
|
||
<i>24- hour washout applied</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
De Meer, Gea; Heederik, Dick; Postma, Dirkje S (2002) Bronchial responsiveness to adenosine 5’-monophosphate (AMP) and methacholine differ in their relationship with airway allergy and baseline FEV(1). American journal of respiratory and critical care medicine
|
||
165(3): 327–31
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/11818315" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11818315</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants not presenting with respiratory symptoms</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
De Souza, A.C.T.G. and Pereira, C.A.C. (2005) Bronchial provocation tests using methacholine, cycle ergometer exercise and free running in children with intermittent asthma. Jornal de Pediatria
|
||
81(1): 65–72
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/15742089" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15742089</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants diagnosed with asthma at study entry</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Deilami, G.D., Khandashpour, M., Paknejad, O.
|
||
et al. (2009) Evaluation of methacholine challenge test results in chronic cough patients referring to clinic of pulmonary disease. Acta Medica Iranica
|
||
47(3): 175–179
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Methacholine challenge used as reference standard to assess diagnostic accuracy of chronic cough of varying durations</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
den Otter, J J, Reijnen, G M, van den Bosch, W J
|
||
et al. (1997) Testing bronchial hyper-responsiveness: provocation or peak expiratory flow variability?. The British journal of general practice : the journal of the Royal College of General Practitioners
|
||
47(421): 487–92
|
||
[<a href="/pmc/articles/PMC1313077/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1313077</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/9302787" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9302787</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Histamine challenge used as reference standard</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Di Lorenzo, Gabriele, Mansueto, Pasquale, Esposito-Pellitteri, Maria
|
||
et al. (2007) The characteristics of different diagnostic tests in adult mild asthmatic patients: comparison with patients with asthma-like symptoms by gastro-oesophageal reflux. Respiratory medicine
|
||
101(7): 1455–61
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/17360170" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17360170</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants already diagnosed with asthma at study entry</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Drake, Sarah, Wang, Ran, Healy, Laura
|
||
et al. (2021) Diagnosing Asthma with and without Aerosol-Generating Procedures. The journal of allergy and clinical immunology. In practice
|
||
9(12): 4243–4251e7
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/34303020" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34303020</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>ICS washout period was 2 weeks - protocol specified a minimum of 4 weeks</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Fitzgerald, J.M. (1996) Relation of airway responsiveness to methacholine to parent and child reporting of symptoms suggesting asthma. Canadian Respiratory Journal
|
||
3(2): 115–123
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants not presenting with respiratory symptoms</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Fruchter, Oren and Yigla, Mordechai (2008) Response to bronchodilators after exercise challenge predicts bronchial hyperreactivity. The Journal of asthma : official journal of the Association for the Care of Asthma
|
||
45(5): 353–6
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/18569226" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18569226</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect outcome</p>
|
||
<p>
|
||
<i>Bronchial hyperresponsiveness</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Garcia-Rio, F, Mediano, O, Ramirez, M
|
||
et al. (2004) Usefulness of bronchial reactivity analysis in the diagnosis of bronchial asthma in patients with bronchial hyperresponsiveness. Respiratory medicine
|
||
98(3): 199–204
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/15002754" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15002754</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Inappropriate interval between index test and reference standard</p>
|
||
<p>
|
||
<i>Two years between histamine challenge and clinician diagnosis</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Ghanei, M, Aliannejad, R, Mazloumi, M
|
||
et al. (2015) Exertional-induced bronchoconstriction: comparison between cardiopulmonary exercise test and methacholine challenging test. Annals of cardiac anaesthesia
|
||
18(4): 479–485
|
||
[<a href="/pmc/articles/PMC4881686/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4881686</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26440232" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26440232</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Methacholine challenge used as reference standard</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Ghodrati, S., Hormati, A., Mousavi, N.N.
|
||
et al. (2011) Comparison of FEV1 and PEF values in cough variant asthma during methacholine challenge test. Journal of Zanjan University of Medical Sciences and Health Services
|
||
19(77): 3
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Giannini, D, Paggiaro, P L, Moscato, G
|
||
et al. (1997) Comparison between peak expiratory flow and forced expiratory volume in one second (FEV1) during bronchoconstriction induced by different stimuli. The Journal of asthma : official journal of the Association for the Care of Asthma
|
||
34(2): 105–11
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/9088296" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9088296</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect outcome</p>
|
||
<p>
|
||
<i>The sensitivity and specificity of different cut-off values of PEF change to detect a 15% decrease in FEV1 from baseline value, not detecting asthma; unclear reference standard</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Giovannini, M, Valli, M, Ribuffo, V
|
||
et al. (2014) Relationship between Methacholine Challenge Testing and exhaled nitric oxide in adult patients with suspected bronchial asthma. European annals of allergy and clinical immunology
|
||
46(3): 109–13
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/24853569" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24853569</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Study design not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Not a diagnostic accuracy study</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Godfrey, Simon, Uwyyed, Kamal, Springer, Chaim
|
||
et al. (2004) Is clinical wheezing reliable as the endpoint for bronchial challenges in preschool children?. Pediatric pulmonology
|
||
37(3): 193–200
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/14966812" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14966812</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Average population age <5 years</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Goldstein, M F, Veza, B A, Dunsky, E H
|
||
et al. (2001) Comparisons of peak diurnal expiratory flow variation, postbronchodilator FEV(1) responses, and methacholine inhalation challenges in the evaluation of suspected asthma. Chest
|
||
119(4): 1001–10
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/11296161" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11296161</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Methacholine challenge test used as part of clinician diagnosis</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Goldstein, Marc F, Veza, Bernadette A, Lauf-Goldstein, Arlene
|
||
et al. (2002) Forced expiratory time and bronchial hyperresponsiveness to methacholine. The Journal of asthma : official journal of the Association for the Care of Asthma
|
||
39(2): 143–50
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/11990229" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11990229</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Diagnostic accuracy result of methacholine inhalation challenge based on correlation with findings from shortened forced expiratory time ( FET100%)</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Higgins, B G, Britton, J R, Chinn, S
|
||
et al. (1992) Comparison of bronchial reactivity and peak expiratory flow variability measurements for epidemiologic studies. The American review of respiratory disease
|
||
145(3): 588–93
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/1546839" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1546839</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants not presenting with respiratory symptoms</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
James, A and Ryan, G (1997) Testing airway responsiveness using inhaled methacholine or histamine. Respirology (Carlton, Vic.)
|
||
2(2): 97–105
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/9441133" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9441133</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Review article but not a systematic review</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Johnson, K T and Funahashi, A (1987) Clinical characteristics and methacholine sensitivity in patients with suspected bronchial asthma. Wisconsin medical journal
|
||
86(4): 17–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/3296484" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3296484</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Study design not relevant to this review protocol</p>
|
||
<p>
|
||
<i>No reference standard included, investigating correlation with symptoms</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Joyce, D P; Chapman, K R; Kesten, S (1996) Prior diagnosis and treatment of patients with normal results of methacholine challenge and unexplained respiratory symptoms. Chest
|
||
109(3): 697–701
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/8617078" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8617078</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- ICS washout period not appropriate</p>
|
||
<p>
|
||
<i>ICS not withheld prior to testing</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
King, D K; Thompson, B T; Johnson, D C (1989) Wheezing on maximal forced exhalation in the diagnosis of atypical asthma. Lack of sensitivity and specificity. Annals of internal medicine
|
||
110(6): 451–5
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/2645821" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2645821</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Methacholine challenge test used as reference standard with wheezing as the index test</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Koskela, Heikki O, Hyvarinen, Liisa, Brannan, John D
|
||
et al. (2003) Responsiveness to three bronchial provocation tests in patients with asthma. Chest
|
||
124(6): 2171–7
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/14665497" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14665497</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants diagnosed with asthma at study entry</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Lee, Eun, Kim, Young-Ho, Han, Seungbong
|
||
et al. (2017) Different cutoff values of methacholine bronchial provocation test depending on age in children with asthma. World journal of pediatrics : WJP
|
||
13(5): 439–445
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/28276002" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28276002</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants diagnosed with asthma prior to study entry</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Li, Bao-Hong, Guan, Wei-Jie, Zhu, Zheng
|
||
et al. (2019) Methacholine bronchial provocation test for assessment of bronchial hyperresponsiveness in preschool children. Journal of thoracic disease
|
||
11(10): 4328–4336
|
||
[<a href="/pmc/articles/PMC6837968/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6837968</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31737318" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31737318</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants not presenting with respiratory symptoms</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Mazi, Ahlam and Lands, Larry C (2014) Effect of lowering methacholine challenge test cutoff in children. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
|
||
113(4): 393–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/25091717" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25091717</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Unclear what the reference standard is</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
McGarvey, L P, Heaney, L G, Lawson, J T
|
||
et al. (1998) Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol. Thorax
|
||
53(9): 738–43
|
||
[<a href="/pmc/articles/PMC1745317/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1745317</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10319055" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10319055</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Histamine challenge test used as part of diagnostic decision</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
McGeady, S.J., Schraeder, B.D., Waxenhiser, Z.
|
||
et al. (1997) Methacholine challenge in detecting bronchial hyperreactivity in children. Pediatric Asthma, Allergy and Immunology
|
||
11(1): 31–38
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Index test does not match review protocol</p>
|
||
<p>
|
||
<i>Using breath units to determine positivity rather than PC20 or PD20</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Nazemiyah, Masoud, Ansarin, Khalil, Nouri-Vaskeh, Masoud
|
||
et al. (2021) Comparison of spirometry and impulse oscillometry in methacholine challenge test for the detection of airway hyperresponsiveness in adults. Tuberkuloz ve toraks
|
||
69(1): 1–8
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/33853300" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33853300</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>No objective test or clinician diagnosis - study used response to therapy as reference standard</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Nieminen, M M (1992) Unimodal distribution of bronchial hyperresponsiveness to methacholine in asthmatic patients. Chest
|
||
102(5): 1537–43
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/1424879" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1424879</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- ICS washout period not appropriate</p>
|
||
<p>
|
||
<i>No washout applied</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Paknejad, O.; Hojjati, S.A.; Pazoki, M. (2011) The association between methacholine challenge test and respiratory symptoms: A study on 146 patients. Tehran University Medical Journal
|
||
68(11): 662–667
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Parameswaran, K; Belda, J; Sears, M R (1999) Use of peak flow variability and methacholine responsiveness in predicting changes from pre-test diagnosis of asthma. The European respiratory journal
|
||
14(6): 1358–62
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/10624767" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10624767</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Index test does not match review protocol</p>
|
||
<p>
|
||
<i>Combination of methacholine and PEF reported, not in isolation (included in 1.11)</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Pedrosa, Maria, Barranco, Pilar, Caminoa, Magdalena
|
||
et al. (2009) Comparison of methacholine and adenosine inhalation challenge in patients with suspected asthma. The Journal of asthma : official journal of the Association for the Care of Asthma
|
||
46(8): 773–6
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/19863279" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19863279</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Index test does not match review protocol</p>
|
||
<p>
|
||
<i>diagnostic accuracy of adenosine monophosphate (AMP) with methacholine used as the reference standard</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Perez, M.P., Falcon, A.R., Galvan, M.F.
|
||
et al. (2015) Comparative study of bronchial provocation tests using methacholine or mannitol in bronchial asthma. European Respiratory Journal
|
||
46(suppl59)
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Pratter, M R; Hingston, D M; Irwin, R S (1983) Diagnosis of bronchial asthma by clinical evaluation. An unreliable method. Chest
|
||
84(1): 42–7
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/6861547" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6861547</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Index test does not match review protocol</p>
|
||
<p>
|
||
<i>Methacholine but PC20/PD20 not used</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Purokivi, Minna, Koskela, Heikki O, Koistinen, Tiina
|
||
et al. (2007) Utility of hypertonic histamine challenge in distinguishing difficult-to-diagnose asthma. The clinical respiratory journal
|
||
1(2): 91–8
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/20298287" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20298287</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Index test does not match review protocol</p>
|
||
<p>
|
||
<i>Hypertonic histamine challenge</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Raji, Hanieh, Haddadzadeh Shoushtari, Maryam, Idani, Esmaeil
|
||
et al. (2018) Forced Expiratory Flow at 25-75% as a Marker for Airway Hyper Responsiveness in Adult Patients with Asthma-like Symptoms. Tanaffos
|
||
17(2): 90–95
|
||
[<a href="/pmc/articles/PMC6320556/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6320556</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30627179" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30627179</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Objective test (spirometry) used without clinician diagnosis</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Remes, S T, Pekkanen, J, Remes, K
|
||
et al. (2002) In search of childhood asthma: questionnaire, tests of bronchial hyperresponsiveness, and clinical evaluation. Thorax
|
||
57(2): 120–6
|
||
[<a href="/pmc/articles/PMC1746240/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1746240</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/11828040" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11828040</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Study included participants already diagnosed with asthma and participants without respiratory symptoms</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Romero-Falcon, Maria Auxiliadora, Medina-Gallardo, Juan Francisco, Lopez-Campos, Jose Luis
|
||
et al. (2022) Evaluation of the Diagnostic Accuracy of Non-Specific Bronchial Provocation Tests in the Diagnosis of Asthma: A Randomized Cross-Over Study. Archivos de bronconeumologia [<a href="https://pubmed.ncbi.nlm.nih.gov/36371327" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36371327</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Response to treatment used as reference standard</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Salvador, R.O., Dijkers, E., Sterk, P.
|
||
et al. (2017) Forced oscillation technique: An alternative outcome measure for methacholine provocation test. European Respiratory Journal
|
||
50(supplement61)
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Shapiro, G G, Furukawa, C T, Pierson, W E
|
||
et al. (1982) Methacholine bronchial challenge in children. The Journal of allergy and clinical immunology
|
||
69(4): 365–9
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/6802893" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6802893</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Study design not relevant to this review protocol</p>
|
||
<p>
|
||
<i>No reference standard</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Siersted, H C, Mostgaard, G, Hyldebrandt, N
|
||
et al. (1996) Interrelationships between diagnosed asthma, asthma-like symptoms, and abnormal airway behaviour in adolescence: the Odense Schoolchild Study. Thorax
|
||
51(5): 503–509
|
||
[<a href="/pmc/articles/PMC473595/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC473595</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/8711678" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8711678</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants not presenting with respiratory symptoms</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Son, K.M., Jang, S.H., Kang, H.R.
|
||
et al. (2009) Role of methacholine PC20 in FEF25-75% for the diagnosis of bronchial asthma. Tuberculosis and Respiratory Diseases
|
||
67(4): 311–317
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Methacholine challenge involved in reference standard</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Spiropoulos, K, Stevens, J, Eigen, H
|
||
et al. (1986) Specificity and sensitivity of methacholine challenge test in children with normal and hyperreactive airways. Acta paediatrica Scandinavica
|
||
75(5): 737–43
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/3564942" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3564942</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Unclear if reference standard (questionnaire) is diagnosing chronic cough or asthma</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Stocks, J.; Tripp, M.; Lin, T. (2014) Methacholine challenge is insufficient to exclude bronchial hyper-responsiveness in a symptomatic military population. Journal of Asthma
|
||
51(8): 886–890 [<a href="https://pubmed.ncbi.nlm.nih.gov/24796649" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24796649</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>No reference standard included</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Suh, D.I.; Lee, J.K.; Koh, Y.Y. (2011) Mannitol challenge test to identify exercise-induced bronchoconstriction and refractoriness. Journal of Allergy and Clinical Immunology
|
||
127(2suppl1): ab6
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Swartz, Edina and Lang, David (2008) When should a methacholine challenge be ordered for a patient with suspected asthma?. Cleveland Clinic journal of medicine
|
||
75(1): 37–40
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/18236728" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18236728</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Not a peer-reviewed publication</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Tan, Jessica H Y, Chew, Wui Mei, Lapperre, Therese S
|
||
et al. (2017) Role of bronchoprovocation tests in identifying exercise-induced bronchoconstriction in a non-athletic population: a pilot study. Journal of thoracic disease
|
||
9(3): 537–542
|
||
[<a href="/pmc/articles/PMC5394074/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5394074</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28449460" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28449460</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Index test does not match review protocol</p>
|
||
<p>
|
||
<i>Exercise challenge was index test, methacholine used as reference standard with no clinician diagnosis</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Ternesten-Hasseus, E, Farbrot, A, Lowhagen, O
|
||
et al. (2002) Sensitivity to methacholine and capsaicin in patients with unclear respiratory symptoms. Allergy
|
||
57(6): 501–7
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/12028115" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12028115</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Methacholine challenge test used as part of reference standard</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Urbankowski, Tomasz and Przybylowski, Tadeusz (2021) Methacholine Challenge Testing: Comparison of FEV1 and Airway Resistance Parameters. Respiratory care
|
||
66(3): 449–459
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/33203723" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33203723</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Methacholine challenge test used as the reference standard</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
van Noord, J A, Clement, J, van de Woestijne, K P
|
||
et al. (1989) Total respiratory resistance and reactance as a measurement of response to bronchial challenge with histamine. The American review of respiratory disease
|
||
139(4): 921–6
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/2930070" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2930070</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Study design not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Study assessing reproducibility of IOS method</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Visser, F.J., van der Vegt, M.J.M.M., van der Wilt, G.J.
|
||
et al. (2010) The optimization of the diagnostic work-up in patients with suspected obstructive lung disease. BMC Pulmonary Medicine
|
||
10: 60
|
||
[<a href="/pmc/articles/PMC2996350/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2996350</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21092293" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21092293</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Study design not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Intervention trial, not a diagnostic accuracy study</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Waked, Myrna, Salameh, Pascale, Attoue, Rim
|
||
et al. (2003) Methacholine challenge test: correlation with symptoms and atopy. Le Journal medical libanais. The Lebanese medical journal
|
||
51(2): 74–9
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/15298161" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15298161</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>No reference standard, instead examines correlations between symptoms and MCT positivity</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Wongtim, S, Mogmeud, S, Limthongkul, S
|
||
et al. (1997) The role of the methacholine inhalation challenge in adult patients presenting with chronic cough. Asian Pacific journal of allergy and immunology
|
||
15(1): 9–14
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/9251842" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9251842</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Methacholine challenge test included in clinician diagnosis</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Woo, Hyeonjin, Samra, Mona Salem, Lim, Dae Hyun
|
||
et al. (2021) Current Asthma Prevalence Using Methacholine Challenge Test in Korean Children from 2010 to 2014. Journal of Korean medical science
|
||
36(19): e130
|
||
[<a href="/pmc/articles/PMC8129620/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8129620</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34002550" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34002550</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Study design not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Epidemiological study, not a diagnostic accuracy study</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Woolcock, A J; Green, W; Alpers, M P (1981) Asthma in a rural highland area of Papua New Guinea. The American review of respiratory disease
|
||
123(5): 565–7
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/7235380" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7235380</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Study design not relevant to this review protocol</p>
|
||
<p>
|
||
<i>No reference standard included</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Yang, C L, Simons, E, Foty, R G
|
||
et al. (2017) Misdiagnosis of asthma in schoolchildren. Pediatric pulmonology
|
||
52(3): 293–302
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/27505297" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27505297</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Population not relevant to this review protocol</p>
|
||
<p>
|
||
<i>Participants diagnosed with asthma prior to study entry</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Yavuz, Suleyman Tolga, Civelek, Ersoy, Tuncer, Ayfer
|
||
et al. (2011) Predictive factors for airway hyperresponsiveness in children with respiratory symptoms. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
|
||
106(5): 365–70 [<a href="https://pubmed.ncbi.nlm.nih.gov/21530866" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21530866</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect outcome</p>
|
||
<p>
|
||
<i>Investigating correlations between symptoms and positive methacholine challenge</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Zainudin, N M, Aziz, B A, Haifa, A L
|
||
et al. (2001) Exercise-induced bronchoconstriction among Malay schoolchildren. Respirology (Carlton, Vic.)
|
||
6(2): 151–5
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/11422895" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11422895</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>No reference standard included</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Zhou, Ming-Juan, Chen, Yuan-Bin, Ouyang, Wen-Wei
|
||
et al. (2021) Diagnostic value of the hypertonic saline bronchial provocation test in children with asthma using the high-power aerosol provocation system. The Journal of asthma : official journal of the Association for the Care of Asthma
|
||
58(5): 625–632
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/31922916" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31922916</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Index test does not match review protocol</p>
|
||
<p>
|
||
<i>Hypertonic saline used as bronchial provocative agent</i>
|
||
</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
Zhu, Wenjing, Liu, Chuanhe, Sha, Li
|
||
et al. (2022) Atypical asthma in children who present with isolated chest tightness: risk factors and clinical features. The Journal of asthma : official journal of the Association for the Care of Asthma
|
||
59(10): 1952–1960
|
||
[<a href="https://pubmed.ncbi.nlm.nih.gov/34559035" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34559035</span></a>]
|
||
</td><td headers="hd_h_niceng245er8.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>- Incorrect reference standard</p>
|
||
<p>
|
||
<i>Methacholine challenge test included as part of clinician diagnosis</i>
|
||
</p>
|
||
</td></tr></tbody></table></div></div></div><div id="niceng245er8.apph.s2"><h4>Health Economic studies</h4><p>Published health economic studies that met the inclusion criteria (relevant population, comparators, economic study design, published 2006 or later and not from non-OECD country or USA) but that were excluded following appraisal of applicability and methodological quality are listed below. See the health economic protocol for more details.</p><div id="niceng245er8.apph.tab2" class="table"><h3><span class="label">Table 11</span><span class="title">Studies excluded from the health economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK611961/table/niceng245er8.apph.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er8.apph.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng245er8.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference</th><th id="hd_h_niceng245er8.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er8.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kennedy 2007(<a class="bk_pop" href="#niceng245er8.s1.ref4">Kennedy et al., 2007</a>)</td><td headers="hd_h_niceng245er8.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Excluded as rated not applicable. Canadian resource use and costs from before 2002/2003 judged unlikely to be applicable to current UK NHS context.</td></tr></tbody></table></div></div></div></div></div><div class="bk_prnt_sctn"><h2>Tables</h2><div class="whole_rhythm bk_prnt_obj bk_first_prnt_obj"><div id="niceng245er8.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of diagnostic accuracy review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK611961/table/niceng245er8.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er8.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng245er8.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng245er8.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>People with suspected asthma (presenting with respiratory symptoms).</p><p><b>Ages stratified into the following 2 groups:</b>
|
||
<ul><li class="half_rhythm"><div>Children/young people (5-16 years old)</div></li><li class="half_rhythm"><div>Adults (≥17 years old)</div></li></ul></p>
|
||
<p><u>Stratified on smoking status:</u>
|
||
<ul><li class="half_rhythm"><div>Smokers</div></li><li class="half_rhythm"><div>Non-smokers</div></li><li class="half_rhythm"><div>Mixed/not reported</div></li></ul></p>
|
||
<p><b>Exclusion</b>:
|
||
<ul><li class="half_rhythm"><div>Children under 5 years old.</div></li><li class="half_rhythm"><div>People on steroid medication (washout period minimum of 4 weeks for inclusion)</div></li><li class="half_rhythm"><div>Occupational asthma /allergens</div></li></ul></p></td></tr><tr><th id="hd_b_niceng245er8.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Target condition</th><td headers="hd_b_niceng245er8.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td></tr><tr><th id="hd_b_niceng245er8.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index test</th><td headers="hd_b_niceng245er8.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>Histamine PC20 and PD20</div></li><li class="half_rhythm"><div>Methacholine PC20 and PD20</div></li></ul></td></tr><tr><th id="hd_b_niceng245er8.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard</th><td headers="hd_b_niceng245er8.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Physician diagnosis of asthma based on symptoms plus an objective test from any one of the following:
|
||
<ul><li class="half_rhythm"><div>Peak flow variability (cut-off value of more than 20% variability as indication of a positive test)</div></li><li class="half_rhythm"><div>Bronchodilator reversibility (cut-off value of an improvement in FEV1 of more than or equal to 12%, and an increase in volume of more than or equal to 200mls as indication of a positive test).</div></li><li class="half_rhythm"><div>FeNO</div></li></ul></p>
|
||
<p>Where no evidence is available using the cut-off values specified above, evidence will be included from studies using a reference standard of physician diagnosis with an objective test using an alternative threshold.</p><p>Where no evidence is available from studies using physician diagnosis and an objective test, evidence will be included from studies using physician diagnosis based on symptoms alone, or patient report of a previous physician diagnosis.</p><p>Maximum interval between initial diagnosis and confirmation of ‘asthma’ diagnosis: 12 months</p></td></tr><tr><th id="hd_b_niceng245er8.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Statistical measures</th><td headers="hd_b_niceng245er8.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma diagnosis
|
||
<ul><li class="half_rhythm"><div>Sensitivity thresholds: upper 90%, lower 10%</div></li><li class="half_rhythm"><div>Specificity thresholds: upper 80%, lower 50%</div></li><li class="half_rhythm"><div>Raw data to calculate 2x2 tables to calculate sensitivity and specificity</div></li><li class="half_rhythm"><div>Negative predictive value (NPV), Positive predictive value (PPV)</div></li></ul></td></tr><tr><th id="hd_b_niceng245er8.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng245er8.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>Cross sectional studies</div></li><li class="half_rhythm"><div>Cohort studies</div></li></ul></td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng245er8.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK611961/table/niceng245er8.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er8.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng245er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng245er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_niceng245er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Target condition</th><th id="hd_h_niceng245er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Index test</th><th id="hd_h_niceng245er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Reference standard</th><th id="hd_h_niceng245er8.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Alberts 1987 (<a class="bk_pop" href="#niceng245er8.s1.ref1">Alberts et al., 1987</a>)</td><td headers="hd_h_niceng245er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>N=19 people referred to a bronchial challenge laboratory with symptoms suggestive of asthma in whom a diagnosis could be confirmed</p>
|
||
<p>Age, mean (range): 38.2 (14-67) years</p>
|
||
<p>USA</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Methacholine challenge test</p>
|
||
<p>Cut-off: PC20 FEV<sub>1</sub> ≤16 mg/mL</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnosis of asthma, or an alternate diagnosis based on clinical information, by the referring physician</td><td headers="hd_h_niceng245er8.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Retrospective cross-sectional study</p>
|
||
<p>Age: Adults</p>
|
||
<p>ICS use: Not reported</p>
|
||
<p>Smoking status: Not reported</p>
|
||
<p>Indirectness: Downgraded by two increments due to population (ICS use not reported, smoking status not reported and included both children/young people and adults) indirectness</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anderson 2009 (<a class="bk_pop" href="#niceng245er8.s1.ref2">Anderson et al., 2009</a>)</td><td headers="hd_h_niceng245er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>N=375 people with signs and symptoms suggestive of asthma according to NIH questionnaire and without a firm diagnosis of asthma</p>
|
||
<p>Age, mean ± SD (range): 24.3 ± 10.2 (6-50) years</p>
|
||
<p>USA</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Methacholine challenge test</p>
|
||
<p>Cut-off: PC20 FEV<sub>1</sub> ≤16 mg/mL</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clinician diagnosis of asthma based on history, examination, skin prick tests, FEV<sub>1</sub> reversibility and exercise challenge results</td><td headers="hd_h_niceng245er8.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Prospective cross-sectional study</p>
|
||
<p>Age: Adults</p>
|
||
<p>ICS use: 4-week washout</p>
|
||
<p>Smoking status: Smokers excluded</p>
|
||
<p>Indirectness: Downgraded by one increment due to population (included both children/young people and adults)</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Hedman 1998 (<a class="bk_pop" href="#niceng245er8.s1.ref3">Hedman et al., 1998</a>)</td><td headers="hd_h_niceng245er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>N= 230 people referred to a pulmonary department due to dyspnoea, wheezing or a cough of unknown cause</p>
|
||
<p>Age, mean (SD): Asthma +ive; 44.0 (16.0), asthma ive; 44.6 (16.2)</p>
|
||
<p>Finland</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Methacholine challenge test</p>
|
||
<p>Cut-offs: PD20 and PD15 FEV<sub>1</sub> ≤6900 μg</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma diagnosis by chest physician using ATS guidelines, including positivity according to bronchial reversibility, PEF variability, skin prick test or exercise test</td><td headers="hd_h_niceng245er8.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Prospective cross-sectional study</p>
|
||
<p>Age: Adults</p>
|
||
<p>ICS use: 4-week washout</p>
|
||
<p>Smoking status: Mixed – 23% and 16% current smokers in bronchial hyperresponsive +ive and -ive, respectively</p>
|
||
<p>Indirectness: Downgraded by one increment due to population (mixed smoking and non-smoking participants) indirectness</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kowal 2009 (<a class="bk_pop" href="#niceng245er8.s1.ref5">Kowal et al., 2009</a>)</td><td headers="hd_h_niceng245er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>N=540 people referred by their family doctor to an asthma clinic for evaluation of chronic cough</p>
|
||
<p>Age, mean (range): 26.5 (18-45) years</p>
|
||
<p>Poland</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Histamine challenge test</p>
|
||
<p>Cut-off: PC20 FEV<sub>1</sub> ≤8 mg/mL</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma was diagnosed over a 6-month period, based on demonstrated signification diurnal changes in PEF or significant bronchial reversibility upon administration of salbutamol</td><td headers="hd_h_niceng245er8.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Prospective cross-sectional study</p>
|
||
<p>Age: Adults</p>
|
||
<p>ICS use: Therapy naïve</p>
|
||
<p>Smoking status: Smokers excluded</p>
|
||
<p>Indirectness: Downgraded by one increment due to reference standard (unclear if clinician diagnosis was involved) indirectness</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Louis 2020 (<a class="bk_pop" href="#niceng245er8.s1.ref6">Louis et al., 2020</a>)</td><td headers="hd_h_niceng245er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Patients with intermittent or chronic respiratory symptoms referred by two asthma physicians for diagnosis (FEV<sub>1</sub> ≥70% predicted for inclusion)</p>
|
||
<p>N=194; mean age (SD): 49 (16) years</p>
|
||
<p>Belgium</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Methacholine challenge</p>
|
||
<p>Cut-off: PC20 ≤8 mg/mL</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bronchodilator response to 400μg salbutamol</td><td headers="hd_h_niceng245er8.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Retrospective cross-sectional study</p>
|
||
<p>Age: Adults</p>
|
||
<p>ICS use: Not previously treated for asthma</p>
|
||
<p>Smoking status: Mixed (22% current smokers)</p>
|
||
<p>Indirectness: Downgraded by two increments due to population (mixed smoking and non-smoking participants) and reference standard (unclear if clinician diagnosis was involved) indirectness</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Popovic Grle 2002 (<a class="bk_pop" href="#niceng245er8.s1.ref9">Popovic-Grle et al., 2002</a>)</td><td headers="hd_h_niceng245er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>N=195 people treated for breathlessness, or referred by their GP because of suspected asthma, at an outpatient allergology department</p>
|
||
<p>Age, mean (SD): 36.8 (6.2)</p>
|
||
<p>Croatia</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Methacholine challenge test</p>
|
||
<p>Cut-off: PC20 FEV<sub>1</sub> ≤8 mg/mL</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnosis of asthma based on questionnaire, history, symptoms and bronchial reversibility</td><td headers="hd_h_niceng245er8.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Prospective cross-sectional study</p>
|
||
<p>Age: Adults</p>
|
||
<p>ICS use: Not reported</p>
|
||
<p>Smoking status: 12% smokers</p>
|
||
<p>Indirectness: Downgraded by one increment due to population (ICS use not reported and mixed smoking and non-smoking participants)</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Porpodis 2017 (<a class="bk_pop" href="#niceng245er8.s1.ref10">Porpodis et al., 2017</a>)</td><td headers="hd_h_niceng245er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>N=88 people with asthma related symptoms in the past month visiting an asthma clinic for asthma diagnosis</p>
|
||
<p>Age, mean (SD): 38.56 (16.73) years</p>
|
||
<p>Greece</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Methacholine challenge test</p>
|
||
<p>Cut-off: PC20 FEV<sub>1</sub> ≤16 mg/mL</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma diagnosis according to GINA guidelines: combination of at least a ≥12% (and ≥200 mL) increase in baseline FEV1 after albuterol, along with new symptoms of coughing, wheezing, or shortness of breath over the past month</td><td headers="hd_h_niceng245er8.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Prospective cross-sectional study</p>
|
||
<p>Age: Adults</p>
|
||
<p>ICS use: Treatment naïve</p>
|
||
<p>Smoking status: 15% current smokers</p>
|
||
<p>Indirectness: Downgraded by one increment due to population (mixed smoking and non-smoking participants) indirectness</p>
|
||
</td></tr><tr><td headers="hd_h_niceng245er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zaczeniuk 2015 (<a class="bk_pop" href="#niceng245er8.s1.ref11">Zaczeniuk et al., 2015</a>)</td><td headers="hd_h_niceng245er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>N=90 people attending an allergic outpatient clinic because of post-exercise symptoms such as cough and shortness of breath</p>
|
||
<p>Age, range: 10-18 years</p>
|
||
<p>Poland</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Methacholine challenge test</p>
|
||
<p>Cut-off: PD20 FEV<sub>1</sub> ≤0.72 mg</p>
|
||
</td><td headers="hd_h_niceng245er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnosis of asthma established based on symptoms, physical examination and positive bronchial reversibility</td><td headers="hd_h_niceng245er8.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Prospective cross-sectional study</p>
|
||
<p>Age: Children/young people</p>
|
||
<p>ICS use: ICS naïve</p>
|
||
<p>Smoking status: Smokers excluded</p>
|
||
<p>Indirectness: Downgraded by one increment due to population (inclusion of both children/young people and adults) indirectness</p>
|
||
</td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng245er8.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: histamine and methacholine challenge tests for the diagnosis of asthma in children/young people</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK611961/table/niceng245er8.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er8.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Studies</th><th id="hd_h_niceng245er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">N</th><th id="hd_h_niceng245er8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_niceng245er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_niceng245er8.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_niceng245er8.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_niceng245er8.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95%CI)</th><th id="hd_h_niceng245er8.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_niceng245er8.tab3_1_1_1_1 hd_h_niceng245er8.tab3_1_1_1_2 hd_h_niceng245er8.tab3_1_1_1_3 hd_h_niceng245er8.tab3_1_1_1_4 hd_h_niceng245er8.tab3_1_1_1_5 hd_h_niceng245er8.tab3_1_1_1_6 hd_h_niceng245er8.tab3_1_1_1_7 hd_h_niceng245er8.tab3_1_1_1_8" id="hd_b_niceng245er8.tab3_1_1_1_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Methacholine challenge (PD20 FEV<sub>1</sub> ≤0.72 mg) vs clinician diagnosis and bronchodilator reversibility</th></tr><tr><td headers="hd_h_niceng245er8.tab3_1_1_1_1 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er8.tab3_1_1_1_2 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">90</td><td headers="hd_h_niceng245er8.tab3_1_1_1_3 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab3_1">1</a></sup></td><td headers="hd_h_niceng245er8.tab3_1_1_1_4 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab3_1_1_1_5 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab3_2">2</a></sup></td><td headers="hd_h_niceng245er8.tab3_1_1_1_6 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab3_3">3</a></sup></td><td headers="hd_h_niceng245er8.tab3_1_1_1_7 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.90 (0.76-0.97)</td><td headers="hd_h_niceng245er8.tab3_1_1_1_8 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er8.tab3_1_1_1_3 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab3_1">1</a></sup></td><td headers="hd_h_niceng245er8.tab3_1_1_1_4 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab3_1_1_1_5 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab3_2">2</a></sup></td><td headers="hd_h_niceng245er8.tab3_1_1_1_6 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab3_4">4</a></sup></td><td headers="hd_h_niceng245er8.tab3_1_1_1_7 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.82 (0.69-0.92)</td><td headers="hd_h_niceng245er8.tab3_1_1_1_8 hd_b_niceng245er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="niceng245er8.tab3_1"><p class="no_margin">Downgraded by two increments due to concerns arising from the method of participant selection (recruitment method unclear), the interpretation of the index test and reference standard (unclear if blinded) and the flow and timing of patients through the study (11 patients excluded due to missing test data)</p></div></dd><dt>2</dt><dd><div id="niceng245er8.tab3_2"><p class="no_margin">Downgraded by one increment due to population (inclusion of both children/young people and adults) indirectness</p></div></dd><dt>3</dt><dd><div id="niceng245er8.tab3_3"><p class="no_margin">Downgraded by one increment due to the 95%CI overlapping the threshold corresponding to ‘high sensitivity’ (90%)</p></div></dd><dt>4</dt><dd><div id="niceng245er8.tab3_4"><p class="no_margin">Downgraded by one increment due to the 95%CI overlapping the threshold corresponding to ‘high specificity’ (80%)</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng245er8.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: histamine and methacholine challenge tests for the diagnosis of asthma in non-smoking adults</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK611961/table/niceng245er8.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er8.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Studies</th><th id="hd_h_niceng245er8.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">N</th><th id="hd_h_niceng245er8.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_niceng245er8.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_niceng245er8.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_niceng245er8.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_niceng245er8.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95%CI)</th><th id="hd_h_niceng245er8.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_niceng245er8.tab4_1_1_1_1 hd_h_niceng245er8.tab4_1_1_1_2 hd_h_niceng245er8.tab4_1_1_1_3 hd_h_niceng245er8.tab4_1_1_1_4 hd_h_niceng245er8.tab4_1_1_1_5 hd_h_niceng245er8.tab4_1_1_1_6 hd_h_niceng245er8.tab4_1_1_1_7 hd_h_niceng245er8.tab4_1_1_1_8" id="hd_b_niceng245er8.tab4_1_1_1_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Methacholine challenge (PC20 FEV<sub>1</sub> ≤16 mg/mL) vs clinician diagnosis with exercise challenge, skin prick and bronchodilator reversibility tests</th></tr><tr><td headers="hd_h_niceng245er8.tab4_1_1_1_1 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er8.tab4_1_1_1_2 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">375</td><td headers="hd_h_niceng245er8.tab4_1_1_1_3 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab4_1">1</a></sup></td><td headers="hd_h_niceng245er8.tab4_1_1_1_4 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab4_1_1_1_5 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab4_2">2</a></sup></td><td headers="hd_h_niceng245er8.tab4_1_1_1_6 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab4_1_1_1_7 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.51 (0.44-0.57)</td><td headers="hd_h_niceng245er8.tab4_1_1_1_8 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er8.tab4_1_1_1_3 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab4_1">1</a></sup></td><td headers="hd_h_niceng245er8.tab4_1_1_1_4 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab4_1_1_1_5 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab4_2">2</a></sup></td><td headers="hd_h_niceng245er8.tab4_1_1_1_6 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab4_3">3</a></sup></td><td headers="hd_h_niceng245er8.tab4_1_1_1_7 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.75 (0.67-0.82)</td><td headers="hd_h_niceng245er8.tab4_1_1_1_8 hd_b_niceng245er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td></tr><tr><th headers="hd_h_niceng245er8.tab4_1_1_1_1 hd_h_niceng245er8.tab4_1_1_1_2 hd_h_niceng245er8.tab4_1_1_1_3 hd_h_niceng245er8.tab4_1_1_1_4 hd_h_niceng245er8.tab4_1_1_1_5 hd_h_niceng245er8.tab4_1_1_1_6 hd_h_niceng245er8.tab4_1_1_1_7 hd_h_niceng245er8.tab4_1_1_1_8" id="hd_b_niceng245er8.tab4_1_1_4_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Histamine challenge (PC20 FEV<sub>1</sub> ≤8 mg/mL) vs diagnosis with PEF variability or bronchodilator reversibility tests</th></tr><tr><td headers="hd_h_niceng245er8.tab4_1_1_1_1 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er8.tab4_1_1_1_2 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">540</td><td headers="hd_h_niceng245er8.tab4_1_1_1_3 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab4_4">4</a></sup></td><td headers="hd_h_niceng245er8.tab4_1_1_1_4 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab4_1_1_1_5 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab4_5">5</a></sup></td><td headers="hd_h_niceng245er8.tab4_1_1_1_6 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab4_6">6</a></sup></td><td headers="hd_h_niceng245er8.tab4_1_1_1_7 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.93 (0.89-0.96)</td><td headers="hd_h_niceng245er8.tab4_1_1_1_8 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er8.tab4_1_1_1_3 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab4_4">4</a></sup></td><td headers="hd_h_niceng245er8.tab4_1_1_1_4 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab4_1_1_1_5 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab4_5">5</a></sup></td><td headers="hd_h_niceng245er8.tab4_1_1_1_6 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab4_1_1_1_7 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 1.00 (0.99-1.00)</td><td headers="hd_h_niceng245er8.tab4_1_1_1_8 hd_b_niceng245er8.tab4_1_1_4_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="niceng245er8.tab4_1"><p class="no_margin">Downgraded by two increments due to concerns arising from the method of participant selection (method not reported) and flow and timing of participants through the study (16 participants excluded from analysis)</p></div></dd><dt>2</dt><dd><div id="niceng245er8.tab4_2"><p class="no_margin">Downgraded by one increment due to population (mixed children/young people and adults) indirectness</p></div></dd><dt>3</dt><dd><div id="niceng245er8.tab4_3"><p class="no_margin">Downgraded by two increments due to the 95%CI overlapping the threshold corresponding to both ‘low and high specificity’ (50% and 80%)</p></div></dd><dt>4</dt><dd><div id="niceng245er8.tab4_4"><p class="no_margin">Downgraded by two increments due to concerns arising from the method of participant selection (method not reported) and interpretation of the index test and reference standard (unclear if blinded)</p></div></dd><dt>5</dt><dd><div id="niceng245er8.tab4_5"><p class="no_margin">Downgraded by one increment due to reference standard (unclear if clinician decision was involved in diagnosis) indirectness</p></div></dd><dt>6</dt><dd><div id="niceng245er8.tab4_6"><p class="no_margin">Downgraded by one increment due to the 95%CI overlapping the threshold corresponding to ‘high sensitivity’ (90%)</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng245er8.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: histamine and methacholine challenge tests for the diagnosis of asthma in adults with mixed/not reported smoking status</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK611961/table/niceng245er8.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er8.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Studies</th><th id="hd_h_niceng245er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">N</th><th id="hd_h_niceng245er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk of bias</th><th id="hd_h_niceng245er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Inconsistency</th><th id="hd_h_niceng245er8.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Indirectness</th><th id="hd_h_niceng245er8.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Imprecision</th><th id="hd_h_niceng245er8.tab5_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect size (95%CI)</th><th id="hd_h_niceng245er8.tab5_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_niceng245er8.tab5_1_1_1_1 hd_h_niceng245er8.tab5_1_1_1_2 hd_h_niceng245er8.tab5_1_1_1_3 hd_h_niceng245er8.tab5_1_1_1_4 hd_h_niceng245er8.tab5_1_1_1_5 hd_h_niceng245er8.tab5_1_1_1_6 hd_h_niceng245er8.tab5_1_1_1_7 hd_h_niceng245er8.tab5_1_1_1_8" id="hd_b_niceng245er8.tab5_1_1_1_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Methacholine challenge (PC20 FEV<sub>1</sub> ≤8 mg/mL) vs clinician diagnosis with bronchodilator reversibility</th></tr><tr><td headers="hd_h_niceng245er8.tab5_1_1_1_1 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er8.tab5_1_1_1_2 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">195</td><td headers="hd_h_niceng245er8.tab5_1_1_1_3 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab5_1">1</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_4 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab5_1_1_1_5 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_2">2</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_6 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab5_1_1_1_7 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.97 (0.93-0.99)</td><td headers="hd_h_niceng245er8.tab5_1_1_1_8 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er8.tab5_1_1_1_3 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab5_1">1</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_4 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_3">3</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_5 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_2">2</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_6 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab5_4">4</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_7 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.83 (0.71-0.92)</td><td headers="hd_h_niceng245er8.tab5_1_1_1_8 hd_b_niceng245er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td></tr><tr><th headers="hd_h_niceng245er8.tab5_1_1_1_1 hd_h_niceng245er8.tab5_1_1_1_2 hd_h_niceng245er8.tab5_1_1_1_3 hd_h_niceng245er8.tab5_1_1_1_4 hd_h_niceng245er8.tab5_1_1_1_5 hd_h_niceng245er8.tab5_1_1_1_6 hd_h_niceng245er8.tab5_1_1_1_7 hd_h_niceng245er8.tab5_1_1_1_8" id="hd_b_niceng245er8.tab5_1_1_4_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Methacholine challenge (PC20 FEV<sub>1</sub> ≤8 mg/mL) vs diagnosis with bronchodilator reversibility</th></tr><tr><td headers="hd_h_niceng245er8.tab5_1_1_1_1 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er8.tab5_1_1_1_2 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">194</td><td headers="hd_h_niceng245er8.tab5_1_1_1_3 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab5_5">5</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_4 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab5_1_1_1_5 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_6">6</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_6 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab5_7">7</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_7 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.82 (0.66-0.92)</td><td headers="hd_h_niceng245er8.tab5_1_1_1_8 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er8.tab5_1_1_1_3 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab5_5">5</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_4 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_3">3</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_5 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_6">6</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_6 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab5_1_1_1_7 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.30 (0.23-0.38)</td><td headers="hd_h_niceng245er8.tab5_1_1_1_8 hd_b_niceng245er8.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td></tr><tr><th headers="hd_h_niceng245er8.tab5_1_1_1_1 hd_h_niceng245er8.tab5_1_1_1_2 hd_h_niceng245er8.tab5_1_1_1_3 hd_h_niceng245er8.tab5_1_1_1_4 hd_h_niceng245er8.tab5_1_1_1_5 hd_h_niceng245er8.tab5_1_1_1_6 hd_h_niceng245er8.tab5_1_1_1_7 hd_h_niceng245er8.tab5_1_1_1_8" id="hd_b_niceng245er8.tab5_1_1_7_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Methacholine challenge (PC20 FEV<sub>1</sub> ≤16 mg/mL) vs bronchodilator reversibility with/without clinician diagnosis or clinician diagnosis without an objective test</th></tr><tr><td headers="hd_h_niceng245er8.tab5_1_1_1_1 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">3 cross-sectional studies</td><td headers="hd_h_niceng245er8.tab5_1_1_1_2 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">301</td><td headers="hd_h_niceng245er8.tab5_1_1_1_3 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_8">8</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_4 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_3">3</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_5 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_9">9</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_6 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab5_7">7</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_7 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.72 (0.33-0.95</td><td headers="hd_h_niceng245er8.tab5_1_1_1_8 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er8.tab5_1_1_1_3 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_8">8</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_4 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_3">3</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_5 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_9">9</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_6 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup><a class="bk_pop" href="#niceng245er8.tab5_10">10</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_7 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.58 (0.23-0.98)</td><td headers="hd_h_niceng245er8.tab5_1_1_1_8 hd_b_niceng245er8.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">VERY LOW</td></tr><tr><th headers="hd_h_niceng245er8.tab5_1_1_1_1 hd_h_niceng245er8.tab5_1_1_1_2 hd_h_niceng245er8.tab5_1_1_1_3 hd_h_niceng245er8.tab5_1_1_1_4 hd_h_niceng245er8.tab5_1_1_1_5 hd_h_niceng245er8.tab5_1_1_1_6 hd_h_niceng245er8.tab5_1_1_1_7 hd_h_niceng245er8.tab5_1_1_1_8" id="hd_b_niceng245er8.tab5_1_1_10_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Methacholine challenge (PD20 FEV<sub>1</sub> ≤6900 μg) vs clinician diagnosis and skin prick testing, PEF variability, bronchodilator reversibility or exercise challenge tests</th></tr><tr><td headers="hd_h_niceng245er8.tab5_1_1_1_1 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er8.tab5_1_1_1_2 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">230</td><td headers="hd_h_niceng245er8.tab5_1_1_1_3 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab5_1_1_1_4 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab5_1_1_1_5 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab5_11">11</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_6 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab5_1_1_1_7 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.77 (0.65-0.87)</td><td headers="hd_h_niceng245er8.tab5_1_1_1_8 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MODERATE</td></tr><tr><td headers="hd_h_niceng245er8.tab5_1_1_1_3 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab5_1_1_1_4 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er8.tab5_1_1_1_5 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab5_11">11</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_6 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup><a class="bk_pop" href="#niceng245er8.tab5_4">4</a></sup></td><td headers="hd_h_niceng245er8.tab5_1_1_1_7 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.82 (0.75-0.87)</td><td headers="hd_h_niceng245er8.tab5_1_1_1_8 hd_b_niceng245er8.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">LOW</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="niceng245er8.tab5_1"><p class="no_margin">Downgraded by one increment due to concerns arising from the interpretation of the index test and reference standard (unclear if blinded in both studies)</p></div></dd><dt>2</dt><dd><div id="niceng245er8.tab5_2"><p class="no_margin">Downgraded by two increments due to population (mixed smoking status and ICS use not reported) indirectness</p></div></dd><dt>3</dt><dd><div id="niceng245er8.tab5_3"><p class="no_margin">Downgraded by two increments due to substantial differences between the point estimate and 95%CI reported in studies reporting the same threshold</p></div></dd><dt>4</dt><dd><div id="niceng245er8.tab5_4"><p class="no_margin">Downgraded by one increment due to the 95%CI overlapping the threshold corresponding to ‘high specificity’ (80%)</p></div></dd><dt>5</dt><dd><div id="niceng245er8.tab5_5"><p class="no_margin">Downgraded by one increment due to concerns arising from the method of participant selection (method not reported)</p></div></dd><dt>6</dt><dd><div id="niceng245er8.tab5_6"><p class="no_margin">Downgraded by two increments due to population (mixed smoking status) and reference standard (unclear clinician decision involved in diagnosis) indirectness</p></div></dd><dt>7</dt><dd><div id="niceng245er8.tab5_7"><p class="no_margin">Downgraded by one increment due to the 95%CI overlapping the threshold corresponding to ‘high sensitivity’ (90%)</p></div></dd><dt>8</dt><dd><div id="niceng245er8.tab5_8"><p class="no_margin">Downgraded by two increments due to concerns arising from the method of participant selection (method not reported), interpretation of the index test and reference standard (unclear if blinded) and the flow and timing of participants through studies (participants missing from final analysis in two of three studies)</p></div></dd><dt>9</dt><dd><div id="niceng245er8.tab5_9"><p class="no_margin">Downgraded by two increments due to population (mixed smoking status and ICS use not reported) and reference standard (unclear clinician decision in diagnosis) indirectness</p></div></dd><dt>10</dt><dd><div id="niceng245er8.tab5_10"><p class="no_margin">Downgraded by two increments due to the 95%CI overlapping the threshold corresponding to both ‘low and high specificity’ (50% and 80%)</p></div></dd><dt>11</dt><dd><div id="niceng245er8.tab5_11"><p class="no_margin">Downgraded by one increment due to population (mixed smoking status) indirectness</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng245er8.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Cost of a bronchial challenge test</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK611961/table/niceng245er8.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er8.tab6_lrgtbl__"><table><thead><tr><th id="hd_h_niceng245er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Resource</th><th id="hd_h_niceng245er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Unit costs</th><th id="hd_h_niceng245er8.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Source</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Bronchial challenge test with methacholine</td><td headers="hd_h_niceng245er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">£179.49</td><td headers="hd_h_niceng245er8.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">National Cost Collection 2021-22 – DZ36Z(<a class="bk_pop" href="#niceng245er8.s1.ref8">NHS England, 2022</a>)</td></tr></tbody></table></div></div></div></div><div><p>Final</p></div><div><p>BTS/NICE/SIGN collaborative guideline NG245</p><p>Developed by BTS, NICE and SIGN</p></div><div><p><b>Disclaimer</b>: The recommendations in this collaborative guideline represent the view of BTS, NICE and SIGN arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>This collaborative guideline covers health and care in England and Scotland. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a> and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. This collaborative guideline is subject to regular review and may be updated or withdrawn.</p></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © BTS, NICE and SIGN.</div><div class="small"><span class="label">Bookshelf ID: NBK611961</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/39937933" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">39937933</a></span></div></div></div>
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