title: Routine pulse oximetry during methacholine challenges is unnecessary for safety.
abstract: BACKGROUND
  Methacholine-induced bronchoconstriction is associated with significant hypoxemia, which can be assessed noninvasively by transcutaneous oxygen tension and pulse oximetry.
  
  
  OBJECTIVE
  To assess the value of the monitoring of finger pulse oximetry during routine methacholine challenges in a clinical pulmonary function laboratory with regard to both safety and the possibility that a significant fall in oxygen saturation as measured by pulse oximetry (SpO(2)) might be a useful surrogate for determining the response to methacholine.
  
  
  METHODS
  Two hundred consecutive patients undergoing diagnostic methacholine challenges in the pulmonary function laboratory of a tertiary-care, university-based referral hospital were studied. Methacholine challenges were performed by the standardized 2-min tidal breathing technique, and the DeltaFEV(1) was calculated from the lowest postsaline solution inhalation to the lowest postmethacholine inhalation value. SpO(2) was measured immediately prior to each spirogram, and the DeltaSpO(2) was measured from the lowest postsaline solution inhalation value to the lowest postmethacholine inhalation value. We examined the data for safety (ie, any SpO(2) value < 90). Based on previous reports, we used a DeltaSpO(2) of > or = 3 as significant and looked at the sensitivity, specificity, and positive and negative predictive values for DeltaSpO(2) > or = 3 vis-à-vis a fall in FEV(1) of > or = 15%.
  
  
  RESULTS
  There were 119 nonresponders (DeltaFEV(1), < 15%) and 81 responders. The baseline FEV(1) percent predicted was slightly but significantly lower in the responders (responders [+/- SD], 91.6 +/- 15%; nonresponders, 96.4 +/- 14%; p < 0.05). DeltaSpO(2) was 3.1 +/- 1.6 in the responders and 1.6 +/- 1.8 in the nonresponders (p < 0. 001). There was a single recording in one patient of SpO(2) < 90 (88). A DeltaSpO(2) > or = 3 had a sensitivity of 68%, a specificity of 73%, a positive predictive value of 63%, and negative predictive value of 77% for a fall in FEV(1) > or = 15%.
  
  
  CONCLUSIONS
  Pulse oximetry is not routinely useful for safety monitoring during methacholine challenge. DeltaSpO(2) is not helpful in predicting a positive spirometric response to methacholine. However, the negative predictive value is adequate to allow the DeltaSpO(2) to be used as an adjunct in assessing a negative result of a methacholine test in patients who have difficulty performing spirometry.
authors.affiliation: Department of Medicine, Division of Respiratory Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada. cockcroft@sask.usask.ca
authors.forename: D W
authors.initials: DW
authors.lastname: Cockcroft
authors.forename: T S
authors.initials: TS
authors.lastname: Hurst
authors.forename: D D
authors.initials: DD
authors.lastname: Marciniuk
authors.forename: D J
authors.initials: DJ
authors.lastname: Cotton
authors.forename: K F
authors.initials: KF
authors.lastname: Laframboise
authors.forename: A K
authors.initials: AK
authors.lastname: Nagpal
authors.forename: R P
authors.initials: RP
authors.lastname: Skomro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001785:Blood Gas Monitoring, Transcutaneous; D001985:Bronchial Provocation Tests / Q000379:methods*; D016085:Bronchoconstrictor Agents; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000139:chemically induced; D008297:Male; D016210:Methacholine Chloride; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012449:Safety; D012680:Sensitivity and Specificity; D012965:Sodium Chloride; D013147:Spirometry
chemical_list: D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride; D012965:Sodium Chloride; D010100:Oxygen