title: Methacholine challenge: test-shortening procedures.
abstract: OBJECTIVE
  Validation of test-shortening procedures for the 2-min tidal breathing methacholine challenge method.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Tertiary-care university clinical pulmonary function laboratory.
  
  
  METHODS
  One thousand subjects aged 10 to 85 years (mean +/- SD, 44.5 +/- 16.0 years), 44.5% male, referred for methacholine challenge.
  
  
  METHODS
  Two-minute tidal breathing methacholine challenge was performed, with both physician and technician access to published test-shortening procedures.
  
  
  RESULTS
  There were 315 positive test results (provocative concentration of methacholine causing a 20% fall in FEV(1) [PC(20)] < or = 8 mg/mL) and 685 negative test results. The subjects with positive test results were less likely to be male (39.1 vs 47.5%; p < 0.02) and had lower FEV(1) (91.8 +/- 14.9% predicted vs 97.2 +/- 13.9% predicted; p < 0.001). The average starting PC(20) was between 0.5 mg/mL and 1.0 mg/mL; the most common PC(20) was 1 mg/mL (67%). There were 431 skipped concentrations in 380 subjects. The mean number of methacholine inhalations was 3.7 +/- 1.1 (3.9 +/- 0.1 for negative test results vs 3.3 +/- 1.2 for positive test results; p < 0.001). Eighteen subjects had a > or = 20% FEV(1) fall on the first inhalation, and 11 subjects had a > or = 20% FEV(1) fall after a skipped concentration. In only one case (0.1%) an FEV(1) fall > or = 40% on the first concentration was reported, compared with no cases after a skipped concentration and seven cases with a > or = 40% FEV(1) fall after a routine doubling dose step-up.
  
  
  CONCLUSIONS
  The 2-min tidal breathing methacholine test in clinical practice can be safely shortened to an average of less than four inhalations using starting concentrations based on FEV(1), asthma medication, and clinical features, and by occasionally omitting concentrations.
authors.affiliation: Division of Respiratory Medicine, Royal University Hospital, Saskatoon, Canada. cockcroft@sask.usask.ca
authors.forename: D W
authors.initials: DW
authors.lastname: Cockcroft
authors.forename: D D
authors.initials: DD
authors.lastname: Marciniuk
authors.forename: T S
authors.initials: TS
authors.lastname: Hurst
authors.forename: D J
authors.initials: DJ
authors.lastname: Cotton
authors.forename: K F
authors.initials: KF
authors.lastname: Laframboise
authors.forename: B D
authors.initials: BD
authors.lastname: McNab
authors.forename: R P
authors.initials: RP
authors.lastname: Skomro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis*; D001985:Bronchial Provocation Tests / Q000379:methods*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D016210:Methacholine Chloride; D008875:Middle Aged; D011237:Predictive Value of Tests
chemical_list: D016210:Methacholine Chloride