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Related Experiment Video

Updated: Feb 15, 2026

Minimal Erythema Dose MED Testing
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Standardizing dose in dosimetric bronchial challenge tests.

Leo Pekka Malmberg1,2, Paula Kauppi3,2, Mika J Mäkelä3,2

  • 1Department of Clinical Physiology, Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland.

Clinical Physiology and Functional Imaging
|January 19, 2018
PubMed
Summary

Nebulizer output in bronchial challenge tests varies with nebulization mode. Standardizing protocols ensures comparable results between different dosimetric systems for assessing asthma hyperresponsiveness.

Keywords:
asthmabronchial hyperresponsivenessmethacholinerespiratory function testsstandardization

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology
  • Medical Device Engineering

Background:

  • Standardized bronchial challenge testing is crucial for assessing airway hyperresponsiveness.
  • Current technical recommendations focus on standardizing the provocative dose of 20% decrease in FEV1 (PD20).
  • Dosimetric systems require precise control over nebulizer output for accurate and reproducible results.

Purpose of the Study:

  • To evaluate the impact of nebulization mode on the output of a computerized dosimeter (APS).
  • To compare PD20 values obtained using the APS system with a standard dosimetric system (Spira) in asthmatic patients.
  • To assess the agreement between the two systems in identifying significant airway hyperresponsiveness.

Main Methods:

  • The output of the APS system was measured under continuous and intermittent nebulization modes with varying actuation durations.
  • A modified methacholine challenge protocol was used with the APS system.
  • Duplicate methacholine challenges were performed on 14 asthma patients using both APS and Spira systems within a short interval.

Main Results:

  • Intermittent nebulization modes produced significantly higher output (mg min⁻¹) compared to continuous mode (P<0.001).
  • APS output in intermittent mode was dependent on pulse duration.
  • PD20 values from APS and Spira systems showed significant correlation (r=0.69; P<0.007) with good agreement in assessing hyperresponsiveness.

Conclusions:

  • Nebulizer output in dosimetric systems is significantly influenced by the mode of nebulization.
  • Consideration of nebulization mode is essential for standardizing bronchial challenge tests across different devices and protocols.
  • Comparable PD20 results can be achieved between different devices if the delivered dose is accurately determined for the specific nebulization mode used.