Bronchoprovocation Agents Study Review - Essay Example

Bronchoprovocation Agents Study Review Research Project Draft One Science Communication and Research Writing Style APA Format Mirroring the Respiratory Research Journal GCU Bio-317V Vicki Arnett April 01, 2012 Abstract Mirroring the same style of the Respiratory Research Journal, writins in this paper consists of an analysis of three different experiments to prove the use of Mannitol as a safe, effective, and more accurate medication in the use of respiratory testing versus the current use of Methacholine.

In the writing of this paper the subject was to mimic the style of the scientific article as closely as possible. A short list of changes made to the APA style of writing includes the title, lack of a title page, and numbered references. The style of writing in all of these articles appears to mimic that of major journal articles presenting data on the subject up front and following with the methodology. One can only assume that the perspective audience just wants the bare bones of each case and to search out details later on when time permits.

Of each article this paper will present the findings, analysis, the results, and critically analysis, the authors’ findings in their conclusions. All details of each article will be summed up in the paper, but extensive care will be taken in order to properly identify the articles authors. Utilizing this method should allow the reader to easily distinguish which experiment the paper is referring to. Introduction Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm.

Symptoms include wheezing, coughing, chest tightness, and shortness of breath. Asthma is clinically classified according to the frequency of symptoms, forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate. Asthma may also be classified as atopic (extrinsic) or non-atopic (intrinsic). It is thought to be caused by a combination of genetic and environmental factors. Treatment of acute symptoms is usually with an inhaled short-acting beta-2 agonist (such as salbutamol). Symptoms can be prevented by avoiding triggers, such as allergens and irritants, and by inhaling corticosteroids.

Leukotriene antagonists are less effective than corticosteroids and thus less preferred. The connection in this paper with the disease process is to focus in the research for mannitol to trigger and attack for testing purposes. Its diagnosis is usually made based on the pattern of symptoms and/or response to therapy over time. The prevalence of asthma has increased significantly since the 1970s. As of 2010, 300 million people were affected worldwide. In 2009 asthma caused 250,000 deaths globally.

Despite this, with proper control of asthma with step down therapy, prognosis is generally good. In fact many children that have asthma during childhood may grow out of by the time they reach adolescence (Maddox 2002). Three articles were chosen to examine the usefulness and current knowledge base of the use of mannitol in respiratory system testing. The first article is by Parkerson and Ledford (2011) entitled “Mannitol as an indirect bronchoprovocation test for the 21st century”. In this article the subject matter consists primarily around the use of mannitol as the best agent for testing asthma patients based off of literature review from practices in Australia, Korea, and the European Union.

The article goes on to talk about the use of the current drugs methacholine and histamine, sighting that these chemicals work directly on the smooth muscle tissue to make the airway react thus giving the health care practitioner an idea of what the patients asthma attack looks like on a pulmonary functions test (PFT). The idea here is to measure the patient’s airway hyperreactivity in a safer and easily measurable manner. The article will be referred to as study A. Since study A does not have a replicable experiment the method analysis of this paper will only contain a short bio of the author’s findings.

The second article is by Brannan, Anderson, Perry, Freed-Martens, Lassig, and Charlton (2005) entitled “The Safety and Efficacy of Inhaled Dry Powder Mannitol as a Bronchial Provocation Test for Airway Hyper-Responsiveness: a phase 3 comparison study with hypertonic saline. In this article the investigators argue that the use of mannitol is superior to that of methacholine. They state that they are able to produce better result due to the specificity of the drug. They make their claim based off of the use of a test called bronchoprovocation.

This article will be referred to as study B. The last article focused on in this paper is a direct comparison of mannitol and methacholine in an exercise induced bronchoconstriction. The article is by Anderson, Charlton (again), Weiler, Nichols, Spector, and Perlman (2009) and was another article published in Respiratory Research. In this article the authors argue that mannitol is better than methacholine in detecting hyperreactivity in exercise because in tests it showed that the use of mannitol when compared to methacholine show a better specificity and sensitivity.

For the purpose of identification in this paper this article will be referred to as study C. Methods The methods in two of the three studies were randomized trials in which subjects were exposed to different inhalants to produce bronchia-hyperreactivity. The third case explains that the research that has been conducted in other countries should be considered in the use of mannitol as a better inhalant that is safer for the use of detecting asthma. Study B For study B, a phase III, Multi-center, open label, operator blind, crossover design, randomized trial, with follow-up.

Asthmatics and non-asthmatics from ages 6-83 were recruited. A total of 592 total subjects completed the study. Mannitol was delivered using a low resistance dry powder inhaler and hypertonic saline was delivered using an ultrasonic nebulizer. The test was conducted by measuring the force exhaled volume in one second (FEV1). The FEV1/FVC ratio, also called Tiffeneau index, is a calculated ratio used in the diagnosis of obstructive and restrictive lung disease (Swanney 2008) was also measured.

The use of this test gave the practitioners the ability to measure whether or not the asthmatics and non-asthmatics responded to the provocation. If the resulting bronchoprovocation was 15% or greater drop in total lung volume it was considered a positive test. Each participate underwent the experiment and kept a seven day journal to report any changes to the doctor in the follow-up visit. Adverse events were monitored throughout the study. Study C In study C the population was slightly smaller than in study B.

In study C, the population size was 509. They ranged in age from 6-50 years old. In this study those with seasonal allergies were not tested. Furthermore those in the test had to have a low NAEPPII asthma score of 1.2. Furthermore broncho-hyperreactivity to exercise was defined as a greater than or equal to 10% drop in forced expiratory volume in 1 second after one second. The clinical diagnosis was made on examination, patient history, sweat tests of the skin, and response to exercise but they were blind to the mannitol and methacholine results.

In this study the patient came in for five clinic visits. Each patient or parent gave informed consent in writing. The protocol was reviewed by the central institutional review board (CIRB) before the trails began. On the first visit the subjects were assessed by demographic data, medical history, medications, spirometry, and allergy skin reactivity tests. Vital signs were taken at each visit that included blood pressure, heart rate, and respiratory rate were measured in the sitting position and electrocardiogram preformed.

Based on this information a pulmonologist working with the subject was given one of six diagnoses at the visit. The diagnoses are as follow: asthma is extremely likely, very likely, probable, possible, unlikely, and extremely unlikely. On the second visit the adverse events, medications, and withholding times were reviewed. Spirometry was performed to mirror the values of the screening day. On this day exercise was performed and measured. On the third visit all of the same measurements were repeated from control only this time the challenge was administered and monitored.

The agent used was hidden from the health care practitioner and the patient as well as the results of the study. The same protocol was followed on the forth visit. The fifth visit was the follow up visit were the subject was given the results of the study. Study A Study A was a result of literary review where trails were selected that established the effect of mannitol as a bronchoprovocation challenge, explored mannitol’s mechanism of action, and compared/ contrasted to other accepted bronchoprovocation challenges like methacholine.

The article explains different trials that were done in the United States and abroad that show data that is highly reproducible in the use of mannitol for bronchoprovocation. Many articles are credited and discussed which makes the article a great starting point for any research done in the field of chemical antagonist for bronchoprovocation study. The article itself credits thirty three different scientific studies performed with the use of the chemical mannitol. Discussion The methods in two of the three studies were randomized trials in which subjects were exposed to different inhalants to produce bronchia-hyperreactivity.

The drug mannitol was compared to methacholine for its efficacy and sensitivity during bronchial challenge test (BCT). A positive test during the BCT was defined by a 15% decrease in the FEV1. A negative test would definitively rule out asthma, but a positive test does not definitely give you a diagnosis of asthma. COPD patients can sometimes get a positive BCT. Mannitol has an advantage to methacholine in that it does not affect the health care practitioner that performs the BCT on the patient.

In a PFT Lab in Florida that has eight full time employees that can perform a BCT using methacholine, only two can officially run the test. Six of eight employees either has an asthma diagnosis or has eventually had an adverse reaction to the methacholine that permits them from performing the test on patients. The lab has switched to the mannitol dry powder test kits manufactured by Aridol. These individual dry powder test kits starts with a low dose and gradually increases while performing spirometry to measure the FEV1.

The dry powder kits is designed that only the patient will get the medication and the health care provider will not get any residual effects. The switch to mannitol instead of methacholine has increased the productivity of the staff and scheduling opportunities, while ensuring the safety of the staff Conclusions. According to the three main articles in this research paper, mannitol is as effective in its efficacy and sensitivity as methacholine. According to some articles sited it should be the new standard of BCT.

Reference 1. Anderson, S. D., Charlton, B., Weiler, J. M., Nichols, S., Spector, S. L., & Pearlman, D. S. et al. (2009). Comparison of mannitol and methacholine to predict exercise-induced bronchoconstriction and a clinical diagnosis of asthma. BioMed Central, 10(4), 1-13. 2. Brannan, J. D., Anderson, S. D., Perry, C. P., Freed-Martens, R., Lassig, A. R., & Charlton, B. (2005). The Safety and efficacy of inhaled dry powder mannitol as a bronchial provocation test for airway hyperresponsiveness: a phase 3 comparison study with hypertonic saline (4.5%). BioMed Central, 6(144), 1-12. 3. Parkinson, J.

, DO, & Ledford, D., MD (2011). Mannitol as an Indirect Bronchoprovocation Test for the 21st Century. American College of Allergy, Asthma, and Immunology, 106(2), 91-96. 4. Maddox L, Schwartz DA (2002). "The pathophysiology of asthma". Annu. Rev. Med. 53: 477–98. doi:10.1146/annurev.med.53.082901.103921. PMID 11818486. 5. NHLBI Guideline 2007, pp. 11–12 6. Swanney MP, Ruppel G, Enright PL, et al (2008). "Using the lower limit of normal for the FEV1/FVC ratio reduces the misclassification of airway obstruction".

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