II. Indication
- Suspected allergen or Exercise-Induced Asthma (despite normal lung function tests)
III. Contraindications
- FEV1 <65% of predicted
IV. Physiology
- Tests airway reactivity to airway constrictors
V. Technique
- Equipment to treat Status Asthmaticus readily available
- Pulmonary Function Tests performed at baseline
- Exposure to airway constrictor or irritant
- Methacholine (most common)
- Mannitol (lower Test Sensitivity than Methacholine but higher Specificity)
- Histamine
- Cold Air
- Hypertonic mist or hypotonic mist
- Pulmonary Function Tests repeated after exposure
VI. Interpretation
- Negative test
- Suggests Asthma not present
- Positive test criteria
- Methacholine
- Exposure to Inhaled Methacholine at 4 mg/ml or less
- FEV1 declines 20%
- Mannitol
- Methacholine
- Positive test
- False Positive in 8% of normal patients
- Asthma
- Emphysema
- Bronchiectasis
- Cystic Fibrosis
VII. Efficacy
- Methacholine Challenge
- Test Sensitivity: 69%
- Test Specificity: 80%
-
Mannitol Inhalation
- Test Sensitivity: 40 to 59%
- Test Specificity: 78 to 100%
-
Eucapnic Voluntary Hyperpnea
- Test Sensitivity: 25 to 90%
- Test Specificity: <71%
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