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Original Article
Specific inhalation challenge: the relationship between response, clinical variables and lung function
  1. Chunshao Hu1,
  2. Maria-Jesus Cruz2,3,
  3. Iñigo Ojanguren2,3,
  4. Miquel de Homdedeu2,
  5. Francisco-Javier Gonzalez-Barcala4,
  6. Xavier Munoz2,3
  1. 1 Pulmonology, Hospital General Universitario Morales Meseguer, Murcia, Spain
  2. 2 Servei de Pneumologia, Hospital Universitari Vall dHebron, Institut de Recerca (VHIR), Universitat Autnoma de Barcelona, Barcelona, Spain
  3. 3 Respiratory, CIBER Enfermedades Respiratorias (Ciberes), Barcelona, Spain
  4. 4 Department of Respiratory, Clinic University Hospital, Santiago de Compostela, Spain
  1. Correspondence to Dr Maria-Jesus Cruz, Servei de Pneumologia Hospital Universitari Vall d’Hebron Passeig Vall d’Hebron, 119129, 08035 Barcelona, Spain; mj.cruz{at}


Introduction The specific inhalation challenge (SIC) is considered the gold standard for the diagnosis of occupational asthma (OA). However, its use is not standardised, and the intensity of exposure is regulated empirically. The aim of this study was to identify clinical variables and/or pulmonary function variables able to predict the scale of patients’ response to SIC.

Material and methods All patients who underwent SIC at our centre between 2005 and 2013 were studied. Anthropometric characteristics, atopic status, type of causal agent, latency times, pulmonary function tests and SIC results were analysed.

Results Two hundred and one patients (51% men) were assessed, of whom 86 (43%) had positive SIC. In the patients with positive results, 29 (34%) were exposed to high molecular weight (HMW) agents and 57 (64%) to low molecular weight (LMW) agents. Patients with a positive SIC exposed to HMW agents had a higher fall in FEV1 after SIC compared with those exposed to LMW agents (p=0.036). The type of asthmatic reaction after SIC also differed between the groups (p=0.020). The logistic regression analysis showed that patients with a higher PC20 before SIC were less likely to have severe decreases in FEV1 after SIC after adjusting for potential confounders (OR=0.771, 95% CI 0.618 to 0.961, p=0.021).

Conclusions The scale of the response to SIC is influenced mainly by the degree of bronchial hyper-responsiveness, regardless of whether the causative agent is HMW or LMW, or whether the response is early or late.

  • High-molecular-weight agents
  • Low-molecular-weight agents
  • Methacholine

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  • Contributors The authors of the manuscript have all contributed significantly to the research, preparation, revision and final production of the manuscript.

  • Funding M-JC is a researcher supported by the Miguel Servet programme organised by the Instituto de Salud Carlos III (CP12/03101).This study was supported by FIS PI15/0190 (Instituto de Salud Carlos III) and FEDER. The funding bodies had no role in the study design, data collection or analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.