A bronchial challenge test is a

medical test A medical test is a medical procedure performed to detect, diagnose, or monitor diseases, disease processes, susceptibility, or to determine a course of treatment. Medical tests such as, physical and visual exams, diagnostic imaging, genetic te ...

used to assist in the

diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engin ...

asthma Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, cou ...

. The patient breathes in nebulized

methacholine Methacholine (International Nonproprietary Name, INN, United States Adopted Name, USAN) (trade name Provocholine), also known as Acetyl-β-methylcholine, is a synthetic choline ester that acts as a non-selective muscarinic receptor agonist in the ...

histamine Histamine is an organic nitrogenous compound involved in local immune responses, as well as regulating physiological functions in the gut and acting as a neurotransmitter for the brain, spinal cord, and uterus. Since histamine was discovered in ...

. Thus the test may also be called a methacholine challenge test or histamine challenge test respectively. Both drugs provoke

bronchoconstriction Bronchoconstriction is the constriction of the airways in the lungs due to the tightening of surrounding smooth muscle, with consequent coughing, wheezing, and shortness of breath. Causes The condition has a number of causes, the most common bei ...

, or narrowing of the airways. Whereas histamine causes nasal and bronchial mucus secretion and bronchoconstriction via the

H1 receptor The H1 receptor is a histamine receptor belonging to the family of rhodopsin-like G-protein-coupled receptors. This receptor is activated by the biogenic amine histamine. It is expressed in smooth muscles, on vascular endothelial cells, in the h ...

, methacholine utilizes the

M3 receptor The muscarinic acetylcholine receptor, also known as cholinergic/acetylcholine receptor M3, or the muscarinic 3, is a muscarinic acetylcholine receptor encoded by the human gene CHRM3. The M3 muscarinic receptors are located at many places in t ...

for bronchoconstriction. The degree of narrowing can then be quantified by

spirometry Spirometry (meaning ''the measuring of breath'') is the most common of the pulmonary function tests (PFTs). It measures lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is he ...

. People with pre-existing airway hyperreactivity, such as

asthmatics Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, cou ...

, will react to lower doses of drug. Sometimes, to assess the reversibility of a particular condition, a

bronchodilator A bronchodilator or broncholytic (although the latter occasionally includes secretory inhibition as well) is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lun ...

is administered to counteract the effects of the bronchoconstrictor before repeating the spirometry tests. This is commonly referred to as a ''reversibility test'', or a ''

post bronchodilator test The post bronchodilator test (Post BD), also commonly referred to as a reversibility test, is a test that utilizes spirometry to assess possible reversibility of bronchoconstriction in diseases such as asthma. Indications This procedure is indica ...

'' (post BD), and may help in distinguishing asthma from

chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...

. Also, a DLCO test can be used to distinguish asthma (normal to high DLCO) from COPD (reduced DLCO). False positives and negatives are possible in the bronchial challenge test. In addition, asthma may be temporary due to an exposure to noxious stimuli or exercise. The bronchial challenge test is physically demanding, and the results can be affected by muscular weakness or exhaustion. The inhaled drug can stimulate the upper airway sufficiently to cause violent coughing. This can make spirometry difficult or impossible. This test is contraindicated in patients with severe airway obstruction due to the obvious worsening of the obstruction. Also contraindicated by the presence of an aortic aneurysm, as spirometry will increase blood pressure, in proportion to both the patient's effort and the degree of obstruction in the lungs.

References

External links

* Medical tests Respiratory system procedures Veterinary diagnosis {{lung-stub