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Bronchial hyper-responsiveness: a technical update.

J Borak1, R Y Lefkowitz1, B Linde1

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Summary
This summary is machine-generated.

Updated guidelines for methacholine challenge testing (MCT) recommend reporting results as PD20, not PC20. This change in bronchial hyper-responsiveness (BHR) testing aims to improve asthma diagnosis sensitivity.

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Area of Science:

  • Pulmonary Medicine
  • Diagnostic Testing
  • Respiratory Physiology

Background:

  • Bronchial hyper-responsiveness (BHR) is a key indicator in asthma diagnosis.
  • Methacholine challenge testing (MCT) is a common BHR test.
  • Recent updates to technical standards for MCT have been issued by the ERS and ATS.

Purpose of the Study:

  • To review updated ERS and ATS guidelines for MCT.
  • To discuss changes in BHR testing methodology.
  • To evaluate the potential impact of these changes on clinical practice.

Main Methods:

  • Systematic review of relevant literature.
  • Medline database search.
  • Hand searches of identified articles.

Main Results:

  • New guidelines recommend tidal breathing instead of deep inspirations for MCT.
  • Results should be reported as PD20 (cumulative dose) rather than PC20 (concentration).
  • Manufacturers must provide nebulizer performance data for PD20 calculation; adoption of new guidelines is slow.

Conclusions:

  • Clinicians must be aware of updated MCT methods and reporting (PD20).
  • PD20 facilitates longitudinal assessment of BHR in asthma patients.
  • Adherence to new guidelines enhances MCT sensitivity in mild/asymptomatic asthma.