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Methods for "indirect" challenge tests including exercise, eucapnic voluntary hyperpnea, and hypertonic aerosols.
Sandra D Anderson1, John D Brannan
1Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, NSW Australia. sandya@mail.med.usyd.edu.au
Clinical Reviews in Allergy & Immunology
|March 20, 2003
Summary
Indirect bronchial provocation tests effectively identify active asthma and monitor treatment response. These tests, using stimuli like hypertonic saline or mannitol, are crucial for assessing exercise-induced bronchoconstriction.
Area of Science:
- Respiratory Medicine
- Pulmonology
- Clinical Immunology
Background:
- Bronchial provocation tests with indirect stimuli identify asthma with high specificity.
- These tests predict response to anti-inflammatory drugs and are valuable for monitoring inhaled steroid treatment.
- Exercise and eucapnic voluntary hyperpnea were early indirect tests, with hypertonic aerosols (saline, mannitol) developed later.
Purpose of the Study:
- To detail protocols for bronchial provocation tests using indirectly acting stimuli.
- To highlight the utility of indirect challenge tests in identifying active asthma and monitoring treatment.
- To underscore the role of these tests in assessing exercise-induced bronchoconstriction.
Main Methods:
- Utilizing stimuli like 4.5% saline aerosols or mannitol powder to mimic evaporative water loss during hyperpnea.
- Employing indirect challenge tests as surrogates for exercise challenges.
- Presenting detailed protocols for administering indirectly acting stimuli.
Main Results:
- Positive indirect challenge tests indicate active airway inflammation and mediator presence (prostaglandins, leukotrienes, histamine).
- Negative tests in known asthmatics suggest good disease control or mild asthma.
- Healthy individuals typically show no significant airway narrowing in response to indirect challenges.
Conclusions:
- Indirect bronchial provocation tests are valuable for identifying active asthma and monitoring anti-inflammatory treatment, particularly inhaled steroids.
- These tests are essential for individuals with occupations or athletic activities prone to exercise-induced bronchoconstriction.
- Indirect tests offer a comprehensive assessment of airway inflammation, unlike direct pharmacological challenges.
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