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Polypharmacy Interactions Impacting Methacholine Challenge Testing for Asthma Assessment in Older People
Demetra E Antimisiaris1, Rodney J Folz2, Rodrigo S Cavallazzi3
11 Department of Health Management and Systems Sciences, Department of Neurology, University of Louisville, Louisville, Kentucky.
The Senior Care Pharmacist
|February 8, 2023
Summary
Certain medications, like anticholinergics and statins, may cause false-negative results in Methacholine Challenge Tests (MCT) for older adults with asthma, impacting diagnosis.
Area of Science:
- Pulmonology
- Clinical Pharmacology
- Geriatric Medicine
Background:
- Physician-diagnosed asthma in older adults presents unique diagnostic challenges.
- Standardized Methacholine Challenge Tests (MCT) are used to assess bronchial hyper-responsiveness.
- An unusually high incidence of negative MCT results was observed in older asthmatic patients.
Purpose of the Study:
- To investigate factors contributing to unexpected negative Methacholine Challenge Test (MCT) results in elderly asthma patients.
- To identify specific medications that may interfere with MCT outcomes despite adherence to medication-hold protocols.
Main Methods:
- Analysis of a longitudinal observational study involving community-dwelling older adults (≥60 years) with physician-diagnosed asthma.
- Inclusion criteria required a positive asthma screening response and either postbronchodilator reversibility or a positive MCT (PC20 ≤ 16 mg/mL).
- Participant data were analyzed for associations between non-medication/medication exposures and negative MCT results.
Main Results:
- Increased anticholinergic burden was significantly associated with negative MCT results.
- Statin use was also positively associated with obtaining negative MCT results.
- These findings suggest certain medications may confound MCT outcomes.
Conclusions:
- Medications not accounted for in standard Methacholine Challenge Test (MCT) medication-hold protocols can influence test results.
- Anticholinergic burden and statin use are potential factors leading to false-negative MCTs in older adults with asthma.
- Clinical interpretation of MCT results in elderly patients should consider concurrent medication use.
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