The predictive value of bronchial histamine challenge in the diagnosis of bronchial asthma.
A prospective survey aiming to study the predictive value of bronchial histamine challenge was performed on 151 patients with a forced expiratory volume1 (FEV1) above 60% of predicted. According to variations in peak expiratory flow rate (PEFR) and medical history the patients were classified as asthmatics (n = 97) or non-asthmatics (n = 54). The diagnostic properties of the challenge were calculated using the statement of Baye. Considering PC20 values below 4.00 mg/ml as positive, the predictive value of a positive test was about 0.80 and the predictive value of a negative about 0.76. When PC20 was below 0.125 mg/ml the predictive value of a positive test was 1.00, but an increase in PC20 in the range from 4.00 to 16 mg/ml did not increase the predictive value of a negative test. In this study the prevalence of asthma was about 0.6. We therefore conclude that bronchial histamine challenge is a valuable test for detection and exclusion of bronchial asthma, when the prevalence of the disease is high. In populations with a lower frequency of bronchial asthma the diagnostic value of a positive bronchial challenge will be negligible.