Inhalation Challenge Test

Aka: Inhalation Challenge Test, Inhalation Bronchial Challenge Test, Methacholine Challenge, Pulmonary Methacholine Challenge Test, Pulmonary Function Challenge Test, Bronchoprovocation

II. Indication

  1. Suspected allergen or Exercise-Induced Asthma (despite normal lung function tests)

III. Contraindications

  1. FEV1 <65% of predicted

IV. Physiology

  1. Tests airway reactivity to airway constrictors

V. Technique

  1. Equipment to treat Status Asthmaticus readily available
  2. Pulmonary Function Tests performed at baseline
  3. Exposure to airway constrictor or irritant
    1. Methacholine (most common)
    2. Mannitol (lower Test Sensitivity than methacholine but higher Specificity)
    3. Histamine
    4. Cold Air
    5. Hypertonic mist or hypotonic mist
  4. Pulmonary Function Tests repeated after exposure

VI. Interpretation

  1. Negative test
    1. Suggests Asthma not present
  2. Positive test criteria
    1. Methacholine
      1. Exposure to Inhaled Methacholine at 4 mg/ml or less
      2. FEV1 declines 20%
    2. Mannitol
      1. Exposure to cummulative dose of 635 mg or less of Mannitol
      2. FEV1 decline of 15% or FEV1 declines 10% between 2 consecutive doses
  3. Positive test
    1. False Positive in 8% of normal patients
    2. Asthma
    3. Emphysema
    4. Bronchiectasis
    5. Cystic Fibrosis

VII. Efficacy

  1. Methacholine Challenge
    1. Test Sensitivity: 69%
    2. Test Specificity: 80%
  2. Mannitol Inhalation
    1. Test Sensitivity: 40 to 59%
    2. Test Specificity: 78 to 100%
  3. Eucapnic Voluntary Hyperpnea
    1. Test Sensitivity: 25 to 90%
    2. Test Specificity: <71%

VIII. References

  1. Langan (2020) Am Fam Physician 101(6): 362-8 [PubMed]
  2. Crapo (2000) Am J Respir Crit Care Med 161:309-29 [PubMed]
  3. Randolph (2011) Curr Allergy Asthma 11(6): 482-90 [PubMed]

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Related Studies

Ontology: Inhalation bronchial challenge testing (C0199440)

Concepts Diagnostic Procedure (T060)
SnomedCT 15435001
English Inhalation bronchial challenge testing, Inhalation bronchial challenge testing (procedure), Inhalation bronchial challenge testing, NOS
Spanish pruebas de provocación de inhalación bronquial (procedimiento), pruebas de provocación de inhalación bronquial
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Pulmonary function challenge test (C1096110)

Concepts Diagnostic Procedure (T060)
Italian Prova di stimolazione della funzione polmonare
Japanese 肺機能負荷試験, ﾊｲｷﾉｳﾌｶｼｹﾝ
Czech Funkční vyšetření plic po stimulaci
Hungarian Pulmonalis funkció terheléses vizsgálat
English Pulmonary function challenge test
Portuguese Exame da função pulmonar
Spanish Prueba de estimulación de la función pulmonar
Dutch pulmonale functie belastingstest
French Test de provocation de la fonction pulmonaire
German pulmonaler Funktionstest
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Pulmonary methacholine challenge test (C1096470)

Concepts Diagnostic Procedure (T060)
Dutch pulmonale methacholine belastingstest
French Test de provocation bronchique à la métacholine
German Methacholin-Provokationstest der Lunge
Italian Test provocativo bronchiale con metacolina
Portuguese Prova pulmonar de sobrecarga de metacolina
Spanish Prueba de estimulación pulmonar con metacolina
Japanese 肺メタコリン負荷試験, ﾊｲﾒﾀｺﾘﾝﾌｶｼｹﾝ
Czech Vyšetření plic po stimulaci metacholinem
Hungarian Pulmonális metakolin terheléses vizsgálat
English Pulmonary methacholine challenge test
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pathology and Laboratory Medicine

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