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Related Experiment Videos

Methacholine challenge: comparison of two methods.

Donald W Cockcroft1, Beth E Davis, David C Todd

  • 1Division of Respiratory Medicine, Department of Medicine, Royal University Hospital, University of Saskatchewan, Ellis Hall, Fifth Floor, Saskatoon, SK, S7N 0W8 Canada. cockcroft@sask.usask.ca

Chest
|March 15, 2005
PubMed
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The 2-minute tidal-breathing methacholine challenge yields approximately double the airway hyperresponsiveness response compared to the five-breath dosimeter method. This difference is more pronounced in mild asthma cases, suggesting the dosimeter method may underestimate airway hyperresponsiveness.

Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • Recent American Thoracic Society (ATS) guidelines published standardized methods for methacholine challenge testing.
  • Two methods, the 2-minute tidal-breathing and the five-breath dosimeter, were proposed.
  • The tidal-breathing method involves higher aerosol exposure per concentration compared to the dosimeter method, yet was presumed to yield equivalent results.

Purpose of the Study:

  • To directly compare the clinical performance and outcomes of the 2-minute tidal-breathing and the five-breath dosimeter methacholine challenge methods.
  • To assess if these two methacholine challenge protocols produce comparable results in quantifying airway hyperresponsiveness (AHR).

Main Methods:

  • A comparative study was conducted in a tertiary care university-based bronchoprovocation laboratory.

Related Experiment Videos

  • Forty subjects with active asthma symptoms participated.
  • The 2-minute tidal-breathing and five-breath dosimeter methacholine challenges were administered in random order on separate days to control for variability.

    • Main Results:

    • The provocation concentration of methacholine causing a 20% fall in FEV(1) (PC(20)) was significantly lower with the tidal-breathing method (1.3 mg/mL) compared to the dosimeter method (2.4 mg/mL) (p < 0.00005).
    • The difference in PC(20) was more substantial in subjects with mild airway hyperresponsiveness (3.2-fold difference) than in those with moderate AHR (1.6-fold difference) (p = 0.04).
    • Three subjects with mild asthma exhibited a non-measurable PC(20) (> 32 mg/mL) with the dosimeter method, whereas their PC(20) was measurable with the tidal-breathing method.

    Conclusions:

    • The 2-minute tidal-breathing methacholine challenge method results in approximately double the bronchoconstrictive response compared to the five-breath dosimeter method.
    • The breath-holding maneuver required for the dosimeter method may potentially inhibit or underestimate the airway hyperresponsiveness response in certain asthma patients.