Methacholine challenge test: Comparison of tidal breathing and dosimeter methods in children

Methacholine Challenge Test (MCT) is used to confirm, assess the severity and/or rule out asthma. Two MCT methods are described as equivalent by the American Thoracic Society (ATS), the tidal breathing and the dosimeter methods. However, the majority of adult studies suggest that individuals with asthma do not react at the same PC₂₀ between the two methods. Additionally, the nebulizers used are no longer available and studies suggest current nebulizers are not equivalent to these. Our study investigates the difference in positive MCT tests between three methods in a pediatric population.

A retrospective, chart review of all MCT performed with spirometry at the Montreal Children's Hospital from January 2006 to March 2016. A comparison of the percentage positive MCT tests with three methods, tidal breathing, APS dosimeter and dose adjusted DA-dosimeter, was performed at different cutoff points up to 8 mg/mL.

A total of 747 subjects performed the tidal breathing method, 920 subjects the APS dosimeter method, and 200 subjects the DA-dosimeter method. At a PC₂₀ cutoff ≤4 mg/mL, the percentage positive MCT was significantly higher using the tidal breathing method (76.3%) compared to the APS dosimeter (45.1%) and DA-dosimeter (65%) methods (P < 0.0001).

The choice of nebulizer and technique significantly impacts the rate of positivity when using MCT to diagnose and assess asthma. Lack of direct comparison of techniques within the same individuals and clinical assessment should be addressed in future studies to standardize MCT methodology in children.