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Relationships of methacholine and AMP responsiveness with peak expiratory flow variability in children with asthma


Dr Young Yull Koh, Department of Pediatrics, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.


Background Both bronchial responsiveness (BR) and peak expiratory flow (PEF) variability are increased in asthma. PEF variability is presumed to reflect the degree of BR in asthma. BR is commonly assessed by bronchial challenges using direct or indirect stimuli.

Objective The aim of this study was to compare methacholine and adenosine 5′-monophosphate (AMP) responsiveness with regard to their relationships with PEF variability in children with asthma.

Methods Methacholine and AMP challenge tests were performed in 79 children with mild to moderate asthma, and a provocative concentration causing a 20% decline in forced expiratory volume in 1 s (PC20) was calculated for each challenge. Subjects recorded PEF each morning and each evening for 14 consecutive days. PEF variability was expressed as amplitude percentage mean (amp%mean; high PEF minus low PEF on each day, expressed as a percentage of their mean, averaged over 14 days), and as the lowest percentage highest (low%high; the lowest PEF expressed as a percentage of the highest PEF recorded over the period).

Results Methacholine PC20 correlated significantly but weakly with both indices of PEF variability (amp%mean: r=−0.285, P=0.011; low%high: r=0.238, P=0.034). However, there was a significant and strong correlation between AMP PC20 and both amp%mean (r=−0.583, P=0.000) and low%high (r=0.496, P=0.000). For AMP PC20, the correlations were stronger than for methacholine PC20 (comparison of correlation coefficients with amp%mean: P=0.021; with low%high: P=0.063).

Conclusion Both methacholine PC20 and AMP PC20 correlated significantly with PEF variability. However, the stronger correlations for AMP PC20 than for methacholine PC20 suggest that PEF variability may be better reflected by BR assessed by AMP than by methacholine.

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