Clinical Investigations Respiration 2005;72:52–60 DOI: 10.1159/000083401 Questionnaire Responses That Predict Airw ay Response to Hypertonic Saline Jörg D. Leuppi a, c Sandra D. Anderson b John D. Brannan b Elena Belousova a Helen K. Reddel a Leanne T. Rodwell b a Woolcock Institute of Medical Research, University of Sydney, Sydney, and b Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia; c Pneumology and Basel Institute for Clinical Epidemiology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland Received: November 20, 2003 Accepted after revision: May 26, 2004 Dr. Sandra D. Anderson Department of Respiratory Medicine, E 11 S Main Building Royal Prince Alfred Hospital, Missenden Road Camperdown, NSW 2050 (Australia) Tel. +61 2 9515 6120, Fax +61 2 9515 8196, E-Mail sandya@mail.med.usyd.edu.au ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2005 S. Karger AG, Basel 0025–7931/05/0721–0052$22.00/0 Accessible online at: www.karger.com/res Key Words Asthma symptoms W Bronchial provocation W Hypertonic saline Abstract Background: Airway hyperresponsiveness to hypertonic saline (HS) is associated with airway inflammation. We investigated if responsiveness to HS was predicted by asthma symptoms in the last 3 months. Objectives: To investigate if responsiveness to HS can be estimated by questionnaire items investigating asthma symptoms of the last 3 months. M ethods: Six hundred and four patients with physician-diagnosed asthma being as- sessed for asthma severity were studied. Bronchial prov- ocation with 4.5% saline was performed, and a question- naire was administered. The response to 4.5% saline was reported as the provoking dose to cause a 15% fall in the forced expiratory volume in 1 s FEV 1 (PD 15 ) and the response-dose ratio (RDR). Results: Based on the GINA guidelines, asthma severity was intermittent in 497 pa- tients, mild in 107 patients, moderate in 3 patients and severe in 1 patient. A PD 15 to 4.5% saline was recorded in 234 of the 604. Questions on self-recognition of asthma, dust as a trigger, food as a trigger, and frequency of bronchodilator use were significant predictors for a PD 15 , and currently taking steroids decreased the likelihood of a positive response to 4.5% saline. Using a multiple- linear regression model, a difference in the RDR could be calculated between those who answered positively com- pared with the reference group, who answered nega- tively. This difference could be used as a guide for pre- dicting abnormal reactivity. An increase in RDR in re- sponse to 4.5% saline, compared with the reference group, was demonstrated in the presence of self-recog- nition of asthma severity, dust and cats as a trigger or use of bronchodilator during sleep hours. Conclusions: Because of the high positive predictive value of HS for identifying patients with asthma it might be that the need for bronchodilator use at night not only predicts airway hyperresponsiveness to HS, it also could reflect the severity of asthma. Copyright © 2005 S. Karger AG, Basel Introduction Questionnaires and bronchial provocation tests (BPTs) are often used to identify persons with asthma [1– 3]. Airway hyperresponsiveness is most commonly mea-