title: Bronchial provocation testing: the future.
abstract: OBJECTIVE
  Performing a bronchial provocation test (BPT) using a direct or indirect stimulus to identify bronchial hyper-responsiveness (BHR) reduces the possibility of over and under-diagnosis of asthma based on history and symptoms. This review discusses some long-held beliefs of BPTs to include or exclude a diagnosis of asthma or exercise-induced bronchoconstriction (EIB).
  
  
  RESULTS
  A high frequency of negative methacholine tests has been reported in 240 patients given a diagnosis of asthma at the end of the study, many of whom had documented EIB. This suggests that a negative methacholine test should not be relied upon to rule out asthma. Further, a positive methacholine test alone should be interpreted with caution as it may reflect airway injury rather than asthma or EIB. Mannitol, an indirect stimulus, identified a similar prevalence of BHR to methacholine and identified more patients than a single exercise test in three studies. However, neither mannitol nor methacholine identified all patients with EIB. Mannitol has a higher specificity for a physician diagnosis of asthma than methacholine.
  
  
  CONCLUSIONS
  It is likely that both a direct test and an indirect test result may be required in some patients in order to confirm or exclude a diagnosis of asthma with certainty.
authors.affiliation: Department of Respiratory & Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Anderson
authors.forename: John D
authors.initials: JD
authors.lastname: Brannan
mesh_terms: D001249:Asthma / Q000175:diagnosis* / Q000503:physiopathology; D001250:Asthma, Exercise-Induced / Q000175:diagnosis / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis*; D001985:Bronchial Provocation Tests / Q000379:methods / Q000639:trends*; D002986:Clinical Trials as Topic; D005080:Exercise Test; D006801:Humans; D018836:Inflammation Mediators / Q000502:physiology; D008353:Mannitol; D016210:Methacholine Chloride
chemical_list: D018836:Inflammation Mediators; D016210:Methacholine Chloride; D008353:Mannitol