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A bronchial challenge test is a medical test used to assist in the diagnosis of asthma. [1] The patient breathes in nebulized methacholine or histamine. Thus the test may also be called a methacholine challenge test or histamine challenge test respectively. Both drugs provoke bronchoconstriction, or narrowing of the airways.
Methacholine is primarily used to diagnose bronchial hyperreactivity, [1] which is the hallmark of asthma and also occurs in chronic obstructive pulmonary disease. This is accomplished through the bronchial challenge test, or methacholine challenge, in which a subject inhales aerosolized methacholine, leading to bronchoconstriction.
Spirometry can also be part of a bronchial challenge test, used to determine bronchial hyperresponsiveness to either rigorous exercise, inhalation of cold/dry air, or with a pharmaceutical agent such as methacholine or histamine.
Bronchial hyperresponsiveness (or other combinations with airway or hyperreactivity, BH used as a general abbreviation) [1] is a state characterised by easily triggered bronchospasm (contraction of the bronchioles or small airways). Bronchial hyperresponsiveness can be assessed with a bronchial challenge test.
Its specificity is comparable to bronchial challenge testing, although less sensitive. [15] [16] This means that a positive eNO test might be useful to rule in a diagnosis of asthma; however, a negative test might not be as useful to rule it out. [17]
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Medication challenge tests, such as the methacholine challenge test, have a lower sensitivity for detection of exercise-induced bronchoconstriction in athletes and are also not a recommended first-line approach in the evaluation of exercise-induced asthma. [13] Mannitol inhalation [14] [15] has been recently approved for use in the United States.
The post bronchodilator test (Post BD), also commonly referred to as a reversibility test, is a test that utilizes spirometry to assess possible reversibility of bronchoconstriction in diseases such as asthma.