Evidence map›Paper›PMID 9302787›Full record

Trial reportThe British journal of general practice : the journal of the Royal College of General Practitioners1997

Testing bronchial hyper-responsiveness: provocation or peak expiratory flow variability?

J J den Otter, G M Reijnen, W J van den Bosch, C P van Schayck, J Molema, C van Weel

Abstract readClinical TrialComparative StudyControlled Clinical Trial

In one paragraph

Trial report in The British journal of general practice : the journal of the Royal College of General Practitioners, 1997. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it

0cells of the map it votes in

7citing papers in PubMed, 1 pooled it

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

Parental smoking, bronchial reactivity and peak flow variability in children.Thorax · 1998
Pooled it
Fecal Microbiota Transplantation Alleviates Airway Inflammation in Asthmatic Rats by Increasing the Level of Short-Chain Fatty Acids in the Intestine.Inflammation · 2025
Article
Value of Fractional Exhaled Nitric Oxide in Diagnosing Mild Asthma Responsive to Inhaled Corticosteroids.Journal of clinical medicine · 2023
Article
Defining high probability when making a diagnosis of asthma in primary care: mixed-methods consensus workshop.BMJ open · 2020
Review
Influence of the practice setting on diagnostic prediction rules using FENO measurement in combination with clinical signs and symptoms of asthma.BMJ open · 2015
Article
Diagnostic accuracy of spirometry in primary care.BMC pulmonary medicine · 2009
Article
Diagnosing asthma in general practice with portable exhaled nitric oxide measurement--results of a prospective diagnostic study: FENO < or = 16 ppb better than FENO < or =12 ppb to rule out mild and moderate to severe asthma [added].Respiratory research · 2009
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

J J den OtterDepartment of General Practice and Social Medicine, Nijmegen University, The Netherlands.

G M Reijnen

W J van den Bosch

C P van Schayck

J Molema

C van Weel

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAssessing bronchial hyper-responsiveness (BHR) is a main diagnostic criterion of asthma. Provocation testing is not readily available in general practice, but peak expiratory flow (PEF) is. Several guidelines promote the use of PEF variability as a diagnostic tool for BHR. This study tested the agreement between histamine challenge testing and PEF variability, and the consequences for diagnosing asthma.

aimTo investigate the possibility of assessing BHR by PEF variability, using a histamine provocation test as a reference.

methodSubjects with signs of symptoms indicating asthma (persistent or recurrent respiratory symptoms or signs of reversible bronchial obstruction) (n = 323) were studied. They had been identified in a population screening for asthma. A histamine provocation test and PEF variability were assessed over a three-week period. Asthma was defined as signs or symptoms together with a reversible airflow obstruction or BHR to the histamine challenge test. BHR was defined as a PC20 histamine of < or = 8 mg/ml or a PEF variability of > or = 15%. Overall correlation between PC20 and PEF variability was calculated using Spearman's rho. Furthermore, a decision tree was constructed to clarify the role of BHR in diagnosing asthma.

resultsThirty-two patients had a reversibility in forced expiratory volume in 1 second (FEV1) of > or = 9% predicted, 131 patients showed a PC20 of < or = 8 and 11 patients had a PEF variability of > or = 15%. Overall correlation was poor at only -0.27 (P < 0.0001). One hundred and fourteen of the 131 patients diagnosed as having asthma when the histamine challenge test was used were not diagnosed by PEF variability.

conclusionPEF variability cannot replace bronchial provocation testing in assessing BHR. This indicates that PEF variability and bronchial provocation do not measure the same aspects of BHR. If BHR testing is required in diagnosing asthma, a bronchial provocation test has to be used in general practice as well.

Indexed as

Bronchial Provocation TestsPeak Expiratory Flow RateAdultAgedAlgorithmsAsthmaBronchial HyperreactivityHistamineHumansMiddle AgedHistamine

Identifiers

PMID9302787

PMCPMC1313077

What OpenQuestion holds

Textmetadata

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.