Guidelines for Methacholine and Exercise Challenge Testing—1999

Abstract

This statement provides practical guidelines and suggestions for methacholine and exercise challenging testing. Specifically, it reviews indications for these challenges, details factors that influence the results, presents brief step-by-step protocols, outlines safety measures, describes proper patient preparation and procedures, provides an algorithm for calculating results, and offers guidelines for clinical interpretation of results. The details are important because methacholine and exercise challenge tests are, in effect, dose-response tests and delivery of the dose and measurement of the response must be accurate if a valid test is to be obtained. These guidelines are geared to patients who can perform good-quality spirometry tests; they are not appropriate for infants or preschool children. They are not intended to limit the use of alternative protocols or procedures that have been established as acceptable methods. We do not discuss the general topic of bronchial hyperresponsiveness (BHR). 100 mg 100 mg 6.25 ml A: 16 mg/ml 3 ml of dilution A 9 ml B: 4 mg/ml 3 ml of dilution B 9 ml C: 1 mg/ml 3 ml of dilution C 9 ml D: 0.25 mg/ml 3 ml of dilution D 9 ml E: 0.0625 mg/ml * Schedule obtained from Methapharm (Brantford, ON, Canada). * This list is provided to simplify access to some sources of equipment. It is not a complete list of all possible sources of acceptable equipment.

Targeting the small airways with dry powder adenosine: a challenging concept

“…Subjects were characterized during a baseline visit assessing impulse oscillometry (IOS), spirometry, body plethysmography and a conventional nebulized AMP bronchoprovocation test. [9–13] Subjects with a positive AMP response (PC 20  ≤ 320 mg ml –1 ) on this baseline visit were included.…”

Feasibility of high-intensity training in asthma

“…Tests were carried out on a separate day from the Mannitol test. Using an inhalation-triggered dosimeter (Spira Respiratory Care Centre Ltd, Hämeenlinna, Finland), subjects inhaled nebulized isotonic saline for baseline measurement followed by 1–5 incremental doses of nebulized methacholine, as described by Crapo [13]. Two minutes after each inhaled dose, a spirometry measurement was carried out.…”

“…Of the 29 included patients, 55% were men, 2 out of 3 were treated with ICS, mean FEV 1 was 84 [13] %pred and mean ACQ score was 1.7 (0.6) (Table 1). A total of 28 (97%) had a mannitol test performed, and of these, 21 (75%) had a positive test.…”

Monitoring Asthma Severity and Response to Treatment

“…Challenges by the inhalation of methacholine or histamine and by exercise have been widely used in the evaluation of asthma with the overall impression that the worse the hyperreactivity the worse the asthma [58, 59, 60]. However, even in the most recent recommendations for the performance of bronchial provocation tests [61], arbitrary criteria have been used to define an abnormal response and this can easily lead to confusion. We have shown that valid normal ranges can be defined statistically and should be used when determining whether a subject with respiratory symptoms is abnormal in terms of bronchial reactivity [62].…”