pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2015-25-1-19-31pulmo-519Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИCLINICAL GUIDELINESИнгаляционные провокационные тесты для диагностики профессиональной бронхиальной астмы: рекомендации Европейского респираторного обществаChallenge inhalation tests in the diagnosis of occupational asthma: the guidelines of European Respiratory SocietyРедакционнаястатьяEditorialArticle2015300420152511931Copyright © Редакционная с., 20152015Редакционная с.Editorial a.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/519

В данном документе содержатся клинические рекомендации по проведению ингаляционных тестов для диагностики профессиональной бронхиальной астмы (ПБА). Представленные Рекомендации разработаны на основе систематического обзора литературы, исследований, проводившихся в крупных медицинских центрах Европы, материалов конференций и мнений экспертов. В статье подробно описана пошаговая процедура выполнения специфических ингаляционных провокационных тестов (СИПТ), в т. ч. требования безопасности, способы ингаляционной доставки провоцирующего вещества и методы оценки результатов. Также обсуждаются недостатки этой процедуры. Ингаляционные провокационные тесты должны выполняться только в условиях медицинских учреждений, где имеется опыт подобного тестирования. В тестах также должны использоваться контрольные провокационные вещества, доза провоцирующего вещества должна повышаться постепенно при тщательном наблюдении пациента во время исследования и как минимум в течение 6 ч после его окончания. При соблюдении всех требований побочные эффекты СИПТ встречаются редко. Положительным результатом теста считается снижение объема форсированного выдоха за 1-ю секунду на #> 15 %исх. Иногда положительный результат может объясняться неспецифической бронхиальной гиперреактивностью, эозинофилией мокроты или повышением содержания оксида азота в выдыхаемом воздухе. Ингаляционные провокационные тесты обладают высокой чувствительностью и специфичностью, поэтому считаются решающим методом диагностики ПБА. 

This consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each step of a SIC, including safety requirements, techniques for delivering agents, and methods for assessing and interpreting bronchial responses. The limitations of the procedure are also discussed. Testing should only be carried out in hospitals where physicians and healthcare professionals have appropriate expertise. Tests should always include a control challenge, a gradual increase of exposure to the suspected agent, and close monitoring of the patient during the challenge and for at least 6 hours afterwards. In expert centres, excessive reactions provoked by SIC are rare. A positive response is defined by a fall in forced expiratory volume in 1 so15 % from baseline. Equivocal reactions can sometimes be clarified by finding changes in nonspecific bronchial responsiveness, sputum eosinophils or exhaled nitric oxide. The sensitivity and specificity of SIC are high but not easily quantified, as the method is usually used as the reference standard for the diagnosis of occupational asthma.

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The authors declare that there are no conflicts of interest present.