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Original Research: LUNG FUNCTION TESTING |

Application of a Shortened Inhaled Adenosine-5′-Monophosphate Challenge in Young Children Using the Forced Oscillation Technique

Graham L. Hall, PhD; Catherine Gangell, PhD; Takayoshi Fukushima, MD; Friedrich Horak, Jr, MD; Hilary Patterson, BE; Stephen M. Stick, PhD; Peter D. Sly, DSc; Peter J. Franklin, PhD
Author and Funding Information

From the Department of Respiratory Medicine (Drs. Hall, Horak, Stick, and Sly), Princess Margaret Hospital for Children, Perth, WA, Australia; the School of Paediatric and Child Health (Drs. Hall, Gangell, Stick, and Franklin), and the Telethon Institute for Child Health Research (Drs. Hall, Gangell, Fukushima, and Sly, and Ms. Patterson), Centre for Child Health Research, University of Western Australia, Perth, WA, Australia; and the Department of Pediatrics and Adolescent Medicine (Dr. Horak), Medical University Vienna, Vienna, Austria.

Correspondence to: Graham L. Hall, PhD, Respiratory Medicine, Princess Margaret Hospital for Children, GPO Box D184, Perth, WA, 6840 Australia; e-mail: graham.hall@health.wa.gov.au


This study was funded by the Asthma Foundation of Western Australia.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(1):184-189. doi:10.1378/chest.08-2848
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Background:  Adenosine-5′-monophosphate (AMP) is an indirect challenge agent thought to reflect allergic airway inflammation. The forced oscillation technique (FOT) is ideal for use in young children and is suitable for inhaled challenge studies in patients who are in this age group. We assessed the agreement between a shortened and a standard AMP challenge and the repeatability of the shortened AMP challenge using FOT as a primary outcome variable.

Methods:  Eighteen children completed a shortened and a standard AMP challenge, and 20 children completed repeated shortened AMP challenges. The children inhaled nebulized AMP tidally for 2 min, following which the presence of wheeze and pulse oximetric saturation (Spo2) was recorded prior to FOT measurement. Testing continued until the maximum dose was reached or until wheeze, a decrease in Spo2 to < 90%, or an increase in respiratory resistance at 8 Hz of 2.0 hPa/s/L or 30% was noted. Concordance was assessed as a binary response, and agreement in provocation concentrations (PCs) causing a response was assessed with intraclass correlations.

Results:  There was a high degree of concordance between the shortened and standard AMP protocols (94%) and repeated shortened AMP protocols (100%). The mean log10 PCs displayed a high degree of agreement for both AMP protocols, with intraclass correlation coefficients of 0.94 (95% confidence interval, 0.85 to 0.98) and 0.94 (95% confidence interval, 0.82 to 0.98), respectively.

Conclusions:  We demonstrated that a shortened AMP challenge that can be applied to young children is comparable to the standard AMP challenge and is highly repeatable. Further studies in young children to assess the clinical role of a shortened AMP challenge using FOT are required.


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