J Riedler, T Reade, M Dalton, D Holst and C Robertson
Department of Thoracic Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.

To evaluate sensitivity and specificity of a 4.5% hypertonic saline challenge for a diagnosis of asthma, we studied 393 schoolchildren (13 to 15 yr of age) with "current wheeze," "former wheeze," and without history of wheeze in a community-based, cross-sectional survey. These children were selected from 2.836 schoolchildren in 26 schools in greater Melbourne, Australia who completed a self-administered questionnaire on respiratory symptoms, allergic rhinitis, and eczema. Three hundred eighty-two of 393 children successfully completed a 4.5% hypertonic saline challenge with increasing inhalation periods, and 365 of 393 performed a 6-min standardized, free running exercise challenge. The prevalence of bronchial hyperresponsiveness to hypertonic saline was 20.4%. Sensitivity and specificity for the hypertonic saline challenge to identify children with "current wheeze" were 47% and 92% respectively and for the exercise challenge, 46% and 88%. The agreement of response to hypertonic saline and to exercise was only moderate (kappa = 0.43). Factors associated with increased response to hypertonic saline in a multivariate logistic regression model were a history of "current wheeze," hay fever, response to the exercise challenge, female sex, and a lower baseline predicted FEV1. These results suggest that a 4.5% hypertonic saline challenge shows sensitivity and specificity similar to a standardized exercise challenge and pharmacologic challenges and a higher sensitivity than cold air hyperventilation and distilled water to identify asthma in children in a field study. Measurement of responsiveness to hypertonic saline may be of value as an objective marker of asthma to compare prevalence studies of bronchial hyperresponsiveness and of asthma over time and between countries.

This article has been cited by other articles:

				C Tabak, A H Wijga, G de Meer, N A H Janssen, B Brunekreef, and H A Smit Diet and asthma in Dutch school children (ISAAC-2) Thorax, December 1, 2006; 61(12): 1048 - 1053. [Abstract] [Full Text] [PDF]

				K Holzer and J A Douglass Exercise induced bronchoconstriction in elite athletes: measuring the fall Thorax, February 1, 2006; 61(2): 94 - 96. [Full Text] [PDF]

				H. O. Koskela, K. M. Kontra, M. K. Purokivi, and J. T. Randell Interpretation of Cough Provoked by Airway Challenges Chest, November 1, 2005; 128(5): 3329 - 3335. [Abstract] [Full Text] [PDF]

				G. de Meer, G. B. Marks, J. C. de Jongste, and B. Brunekreef Airway responsiveness to hypertonic saline: dose-response slope or PD15? Eur. Respir. J., January 1, 2005; 25(1): 153 - 158. [Abstract] [Full Text] [PDF]

				S.K. Weiland, B. Bjorksten, B. Brunekreef, W.O.C. Cookson, E. von Mutius, D.P. Strachan, and the International Study of Asthma and Allergies in Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II): rationale and methods Eur. Respir. J., September 1, 2004; 24(3): 406 - 412. [Abstract] [Full Text] [PDF]

				K. W. Rundell, S. D. Anderson, B. A. Spiering, and D. A. Judelson Field Exercise vs Laboratory Eucapnic Voluntary Hyperventilation To Identify Airway Hyperresponsiveness in Elite Cold Weather Athletes Chest, March 1, 2004; 125(3): 909 - 915. [Abstract] [Full Text] [PDF]

				A. D. Smith, J. O. Cowan, S. Filsell, C. McLachlan, G. Monti-Sheehan, P. Jackson, and D. R. Taylor Diagnosing Asthma: Comparisons between Exhaled Nitric Oxide Measurements and Conventional Tests Am. J. Respir. Crit. Care Med., February 15, 2004; 169(4): 473 - 478. [Abstract] [Full Text] [PDF]

				J. J. Sturm, K. Yeatts, and D. Loomis Effects of Tobacco Smoke Exposure on Asthma Prevalence and Medical Care Use in North Carolina Middle School Children Am J Public Health, February 1, 2004; 94(2): 308 - 313. [Abstract] [Full Text] [PDF]

				T. Nicolai, D. Carr, S.K. Weiland, H. Duhme, O. von Ehrenstein, C. Wagner, and E. von Mutius Urban traffic and pollutant exposure related to respiratory outcomes and atopy in a large sample of children Eur. Respir. J., June 1, 2003; 21(6): 956 - 963. [Abstract] [Full Text] [PDF]

				G.F. Joos and B. O'Connor Indirect airway challenges Eur. Respir. J., June 1, 2003; 21(6): 1050 - 1068. [Abstract] [Full Text] [PDF]

				J. Crane, J. Mallol, R. Beasley, A. Stewart, and M.I. Asher Agreement between written and video questions for comparing asthma symptoms in ISAAC Eur. Respir. J., March 1, 2003; 21(3): 455 - 461. [Abstract] [Full Text] [PDF]

				P. G. GIBSON, J. L. SIMPSON, A. C. CHALMERS, R. C. TONEGUZZI, P. A. B. WARK, A. J. WILSON, and M. J. HENSLEY Airway Eosinophilia Is Associated with Wheeze But Is Uncommon in Children with Persistent Cough and Frequent Chest Colds Am. J. Respir. Crit. Care Med., September 15, 2001; 164(6): 977 - 981. [Abstract] [Full Text] [PDF]

				X. Xu, T. Niu, C. Chen, B. Wang, Y. Jin, J. Yang, and S. T. Weiss Association of Airway Responsiveness With Asthma and Persistent Wheeze in a Chinese Population Chest, March 1, 2001; 119(3): 691 - 700. [Abstract] [Full Text] [PDF]

				A. H. Eliasson Blow Dry Your Asthma Chest, March 1, 1999; 115(3): 608 - 609. [Full Text] [PDF]

				P. G. GIBSON, J. W. WLODARCZYK, M. J. HENSLEY, M. GLEESON, R. L. HENRY, A. W. CRIPPS, and R. L. CLANCY Epidemiological Association of Airway Inflammation with Asthma Symptoms and Airway Hyperresponsiveness in Childhood Am. J. Respir. Crit. Care Med., July 1, 1998; 158(1): 36 - 41. [Abstract] [Full Text] [PDF]

				A. B Chang, P. D Phelan, J. B Carlin, S. M Sawyer, and C. F Robertson A randomised, placebo controlled trial of inhaled salbutamol and beclomethasone for recurrent cough Arch. Dis. Child., July 1, 1998; 79(1): 6 - 11. [Abstract] [Full Text]

				S. D. ANDERSON, J. BRANNAN, J. SPRING, N. SPALDING, L. T. RODWELL, K. CHAN, I. GONDA, A. WALSH, and A. R. CLARK A New Method For Bronchial-provocation Testing in Asthmatic Subjects Using a Dry Powder of Mannitol Am. J. Respir. Crit. Care Med., September 1, 1997; 156(3): 758 - 765. [Abstract] [Full Text] [PDF]