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Summary
This summary is machine-generated.

This review traces the evolution of airway hyper-responsiveness tests, from early exercise challenges to modern mannitol and saline challenges, improving asthma diagnosis and treatment assessment.

Keywords:
airway hyperresponsivenessdisodium cromoglycatedry powder mannitoleucapnic hyperpnoeaexercisehypertonic salineindirect challenges

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Area of Science:

  • Respiratory Medicine
  • Clinical Immunology
  • Pulmonary Physiology

Background:

  • Indirect bronchoconstriction challenges identify airway hyper-responsiveness by triggering mediator release.
  • Historically, exercise was the first standardized challenge for exercise-induced asthma (EIA).
  • Evolving challenges aim for greater safety, simplicity, and cost-effectiveness in clinical practice.

Purpose of the Study:

  • To review the historical development of indirect airway challenges.
  • To highlight the progression from exercise to eucapnic voluntary hyperpnoea (EVH), hypertonic saline, and mannitol challenges.
  • To emphasize their role in diagnosing asthma and assessing treatment efficacy.

Main Methods:

  • Review of historical development of exercise, EVH, hypertonic saline, and mannitol challenges.
  • Discussion of the underlying physiological principles (water loss, osmolarity changes).
  • Focus on clinical application, standardization, and measurement of forced expiratory volume in 1 sec.

Main Results:

  • Exercise challenge was the first clinical test for EIA.
  • EVH served as a surrogate for exercise, linking EIA to airway water loss.
  • Hypertonic saline and mannitol challenges provide osmotic stimuli, simplifying testing.
  • All methods demonstrate high specificity for active asthma and assess treatment benefits.

Conclusions:

  • Indirect airway challenges have evolved over 50 years to become safer, simpler, and more cost-effective.
  • These standardized tests are crucial for diagnosing asthma and monitoring therapeutic responses.
  • Current methods are recommended for routine clinical practice and guideline inclusion.