Provocative challenges to help diagnose and monitor asthma: exercise, methacholine, adenosine, and mannitol.
OBJECTIVE
To review bronchial provocations tests used in the measurement of bronchial hyperresponsiveness to help in the diagnosis of asthma.


RESULTS
The bronchial provocations tests reviewed include exercise, methacholine, AMP and mannitol, with reference to methodology and monitoring of treatment.


CONCLUSIONS
Methacholine is used for identifying bronchial hyperresponsiveness and to guide treatment. Exercise is used as a bronchial provocation test because demonstrating prevention of exercise-induced asthma is an indication for use of a drug. Both of these tests are being used to study tolerance to beta2 agonists. There is increasing use of eucapnic voluntary hyperpnea as a surrogate bronchial provocation test for exercise to identify exercise-induced asthma, particularly in athletes. For methacholine and AMP there is concern about the different breathing patterns used to inhale these aerosols and the impact they have on the cutoff point for identifying bronchial hyperresponsiveness. A new test that uses a kit containing prepacked capsules of different doses of mannitol and a delivery device is discussed. There is increasing interest in using tests that act indirectly by release of mediators because the bronchial hyperresponsiveness itself is an indicator of the presence of inflammation. Since treatment of inflammation leads to loss of bronchial hyperresponsiveness to indirect stimuli, these tests are well suited to identify success of treatment.
Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. sandya@med.usyd.edu.au
Sandra D
SD
Anderson
D000241:Adenosine; D000293:Adolescent; D058666:Adrenergic beta-2 Receptor Agonists; D000318:Adrenergic beta-Agonists / Q000494:pharmacology; D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis*; D001985:Bronchial Provocation Tests / Q000379:methods*; D016085:Bronchoconstrictor Agents; D002648:Child; D002675:Child, Preschool; D015444:Exercise; D006801:Humans; D008353:Mannitol; D016210:Methacholine Chloride; D012129:Respiratory Function Tests
D058666:Adrenergic beta-2 Receptor Agonists; D000318:Adrenergic beta-Agonists; D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride; D008353:Mannitol; D000241:Adenosine