The use of 4.5% hypertonic saline challenge test in diagnosing asthma in children with chronic recurrent cough

  • Bambang Supriyatno
  • Dina Medina
  • Alan R Tumbelaka
  • Nastiti N Rahajoe
Keywords: 4.5% hypertonic saline challenge test, bronchial provocation test, asthma, chronic recurrent cough


Background The 4.5% hypertonic saline (HS) challenge test has
several benefits compared to histamine challenge test as gold stan-
dard. Saline is an inexpensive non-pharmacological substance
which is relatively safe. Its mechanism in inducing bronchospasm
resembles that of asthma. Moreover, it can easily be made in a
modest medical laboratory.
Objective To determine the ability of 4.5% HS challenge test com-
pared to histamine challenge test in diagnosing asthma in children
with chronic recurrent cough (CRC).
Methods This study was a diagnostic test on children with CRC
aged 6 to 14 years, conducted in outpatient clinic of Department of
Child Health, Cipto Mangunkusumo Hospital, Jakarta. All subjects
underwent lung function tests. Subjects whose FEV 1 was <80% were
diagnosed as asthmatic and underwent the 4.5% HS challenge test
only. Those whose FEV 1 was 80% underwent the histamine chal-
lenge test followed by the 4.5% HS challenge test one or two weeks
later. Test results were expressed as positive or negative. Based on
the results, we calculated the sensitivity, specificity, predictive val-
ues, and likelihood ratios of the 4.5% HS challenge test.
Results Forty-five subjects, consisting of 22 boys and 23 girls,
were enrolled. The average age of subjects was 9 years old. Atopic
history in the family or in subjects themselves was found in 80% of
subjects. Eight subjects had FEV 1 of <80%. Forty-four subjects
were diagnosed with asthma based on a baseline FEV 1 of <80%
or a positive histamine provocation test. Thirty-seven subjects had
a positive 4.5% HS challenge test; all had asthma. Sensitivity and
specificity of the 4.5% HS challenge test were 84.1% and 100.0%,
respectively; the positive and negative predictive values were
100.0% and 12.5%, respectively. The positive likelihood ratio was
infinite and negative likelihood ratio was 0.16.
Conclusion The 4.5% hypertonic saline challenge test can be used
as an alternative bronchial provocation test in diagnosing asthma in
children with CRC. Further study with larger sample size is needed
for widespread usage.

Author Biographies

Bambang Supriyatno
Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.
Dina Medina
Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.
Alan R Tumbelaka
Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.
Nastiti N Rahajoe
Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.


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How to Cite
Supriyatno B, Medina D, Tumbelaka A, Rahajoe N. The use of 4.5% hypertonic saline challenge test in diagnosing asthma in children with chronic recurrent cough. PI [Internet]. 10Oct.2016 [cited 26Sep.2023];45(3):93-. Available from:
Received 2016-10-05
Accepted 2016-10-05
Published 2016-10-10