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Diagnosing Asthma- Bronchoprovocation Challenge Testing

When Is Bronchoprovocation Challenge Testing Needed In Diagnosing Asthma


Updated June 18, 2014

Diagnosing Asthma- Bronchoprovocation Challenge Testing

Methacholine- Bronchoprovocation Challenge Testing

Photo © Flickr user Laurie Blundell

What Is Bronchoprovocation Challenge Testing

Bronchoprovocation tests help asthma care providers make a diagnosis of asthma. In general, you will inhale a nebulized solution or preform exercise to see if you develop symptoms of asthma or airflow obstruction measured by spirometry. If you develop either, your airways are hyperresponsive. Your asthma care provider may challenge you with:

  • Methacholine
  • Histamine
  • Cold Air
  • Exercise

Why Would My Asthma Provider Order a Bronchoprovocation Challenge?

A common scenario for asthma care providers to order bronchoprovocation testing is if you have symptoms that suggest asthma, but normal spirometry testing and no response to rescue medications. Obstruction of airflow in your lungs can be provoked by inhaling aerosols known to elicit asthma symptoms and cause airway narrowing and irritation.

How is Bronchoprovocation Testing Preformed?

You will begin by inhaling a nebulized aerosol with one of the previously mentioned agents as if you were taking a normal breathing treatment. The nebulized treatments will be repeated at specific time increments. You will preform spirometry before and after each nebulized treatment, and your asthma care provider will look at the decrease in FEV1.

What Do My Results Mean?

A decline in FEV1 of 20% from your baseline reading is considered a positive test. If your asthma care provider suspects asthma, you may be started on an asthma treatment.

Hyperresponsiveness reliably discriminates between patients with asthma from patients without asthma. Bronchoprovocation testing has a high negative predictive value. Thus, if you have a negative test, it is unlikely you have asthma.

Bronchoprovocation Testing Is Not For Everyone

Not everyone should have bronchoprovocation challenge testing because there is a risk it may lead to a potentially severe asthma attack. If you have any of the following, you need to discuss with your asthma care provider whether or not testing is appropriate for you:

  • Moderate (FEV1 <60% predicted) or severe (FEV1 of < 50% of predicted) airway obstruction
  • A heart attack in the last 3 months
  • Uncontrolled hypertension (systolic > 200 mm Hg or diastolic > 100 mm Hg)
  • Aortic aneurysm
  • Pregnant or nursing mother
  • Myasthenia Gravis


National Heart, Lung, and Blood Institute. Accessed: January 1, 2009. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma

Clinical Pulmonary Function Testing, Exercise Testing, and Disability Evaluation. In Chest Medicine: Essentials Of Pulmonary And Critical Care Medicine. Editors: Ronald B. George, Richard W. Light, Richard A. Matthay, Michael A. Matthay. May 2005, 5th edition.

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