Bronchial methacholine challenge – the current state of knowledge
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Published:
Nov 13, 2014
Keywords:
asthma, metacholine, bronchial hyperreactivity, bronchial challenge test
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Abstract
The bronchial hyperreactivity is the inseparable feature of asthma. The methacholine challenge test is the main standardized method of the quantitative evaluation of bronchial hyperreactivity. Fifteen years ago it was accepted, that two aerosol delivery systems, i.e. five-breath dosimeter method and 2-min tidal breathing, are equivalent. The authors of this paper tried to sum up hitherto existing knowledge on the topic of the bronchial methacholine challenge. Works published after the year 2000 show that results of methacholine challenge led two mentioned higher methods differ at persons with mild BHR significantly. Because new inhalers and nebulizers recommended by manufacturers to bronchial provocative tests appear on the market, more far investigations over standardization of the procedure are necessary.
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Siergiejko , Z., Siergiejko , G., Siergiejko , D., Siergiejko , P., Krupa , A., & Świebocka , E. (2014). Bronchial methacholine challenge – the current state of knowledge. Alergoprofil, 10(4), 9-15. Retrieved from https://journalsmededu.pl/index.php/alergoprofil/article/view/819
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Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
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2. Sterk P.J., Bel E.H.: Bronchial hyperresponsiveness: The need a distinction between hypersensitivity and excessive airway narrowing. Eur. Respir. J. 1989, 2: 267-274.
3. Siergiejko Z.: Farmakologiczna modulacja reaktywności oskrzeli. Rozprawa habilitacyjna, Uniwersytet Medyczny w Białymstoku, Białystok 1997.
4. Ulotka handlowa Provocholiny®, Methapharm Inc.
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6. Curry J.J.: Comparative action of acethyl-beta-methyl choline and histamine on the respiratory tract in normals, patients with hay fever, and subjects with bronchial asthma. J. Clin. Invest. 1947, 26(3): 430-438.
7. Curry J.J.: The action of histamine on the respiratory tract in normal and asthmatic subjects. J. Clin. Invest. 1946, 25: 785.
8. Tiffenau R., Pinelli A.: Air circulant et air captif dans i’exploration de la fonction ventilatrice pulmonaire. Paris Med. 1947, 37: 624-628.
9. Yernault J.C.: The birth and development of the forced expiratory manoevre: a tribute to Robert Tiffenau (1910-1961). Eur. Respir. J. 1997, 10: 2704-2710.
10. Felarca A.B., Itkin I.H.: Studies with the quantitative-inhalation challenge technique. I. Curve of dose response to acetyl-beta-methylcholine in patients with asthma of known and unknown origin, hay fever subjects, and nonatopic volunteers. J. Allergy 1966, 37(4): 223-235.
11. Droszcz W., Ajewski Z.: The value of bronchodilatatory test and acetylcholine provocation test in the diagnosis of bronchospastic conditions. Gruźlica 1965, 33: 287-293.
12. Aas K.: Bronchial provocation tests in asthma. Arch. Dis. Child. 1970, 45: 221-228.
13. Spector S.L., Farr R.S.: A comparison of methacholine and histamine inhalations in asthmatics. J. Allergy Clin. Immunol. 1975, 56: 308-316.
14. Chai H., Farr R.S., Froehlich L.A. et al.: Standardization of bronchial inhalation challenge procedures. J. Allergy Clin. Immunol. 1975, 56: 323-327.
15. Fish J.E., Rosenthal R.R., Batra G. et al.: Am. Rev. Respir. Dis. 1976, 113: 579-586.
16. Klaustermeyer W.B., Hale F.C., Prescott E.J.: Analysis of the methacholine response in bronchial asthma. Ann. Allergy 1979, 43: 237-240.
17. Guidelines for standardization of bronchial challenges with (nonspecific) bronchoconstriction agents. Eiser N.M., Kerrebijn K.F., Quanjer P.H. (red.). Bull. Eur. Physiopathol. Respir. 1983, 19: 495-514.
18. Cockcroft D.W., Berscheid B.A.: Effect of pH on bronchial response to inhaled histamine. Thorax 1982, 37: 133-136.
19. Cockcroft D.W., Berscheid B.A.: Slope of the dose-response curve: usefulness in assessing bronchial responses to inhaled histamine. Thorax 1983, 38: 55-61.
20. Cockcroft D.W., Berscheid B.A., Murdock K.Y.: Measurement of responsiveness to inhaled histamine using FEV1: comparison of PC20 and treshold. Thorax 1983, 38: 523-526.
21. Ryan G., Dolovich M.B., Obminski G. et al.: Standardization of inhalation provocation tests: influence of nebulizer output, particle size, and method of inhalation. J. Allergy Clin. Immunol. 1981, 67(2): 156-161.
22. Ryan G., Dolovich M.B., Roberts F.S. et al.: Standardization of inhalation provocation tests: two techniques of aerosol generation and inhalation compared. Am. Rev. Respir. Dis. 1981, 123: 195-199.
23. Cockcroft D.W., Berscheid B.A.: Standardization of inhalation provocation tests. Dose vs concentration of histamine. Chest 1982, 82(5): 572-575.
24. Rutkowski R., Siergiejko Z., Hofman J. et al.: Wpływ pirenzepiny na reaktywność oskrzeli ocenianą testem metacholinowym metodą ślepej próby u chorych na dychawicę oskrzelową. Pneum. Pol. 1989, LVII: 10-12.
25. Rosenthal R.R.: Metodologies of aerosol delivery. W: Provocation testing in clinical practice. Spector S.L. (red.). Marcel Dekker, New York 1995: 215-229.
26. Shapiro G.G., Simon R.A., for the Amercican Academy of Allergy and Immunology Bronchoprovocation Commmitte: Bronchoprovocation committee report. J. Allergy Clin. Immunol. 1992, 89: 775-778.
27. Sterk P.J., Fabri L.M., Quanjer P.H. et al.: Airway responsiveness: standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Statement of the European Respiratory Society. Eur. Respir. J. 1993, 6(Suppl.16): 53-83.
28. Juniper E.F., Cockcroft D.W., Hargreave F.E.: Tidal breathing method. In histamine and methacholine inhalation tests: Laboratory procedure and standardization. Wyd. II. Astra Draco AB, 1994, Lund, Szwecja.
29. [online: http://www.ginasthma.org].
30. Anderson S.D., Brannan J., Spring J. et al.: A new method for bronchial provocation testing in asthmatic subject using a dry powder mannitol. Am. J. Respir. Crit. Care Med. 1997, 156: 758-765.
31. Anderson S.D., Charlton B., Weiler J.M. et al.: A305 Study Group comparison of mannitol and methacholine to predict excercise-induced bronchoconstriction and clinical diagnosis of asthma. Respir. Res. 2009, 10: 4.
32. Świebocka E.M., Siergiejko G., Siergiejko Z.: Mannitol challenge does not confirm bronchial hyperreactivity in some histamine-responsive asthmatic children. J. Asthma 2012, 48: 817-821.
33. Fish J.E., Ankin M.G., Kelly J.F. et al.: Regulation of bronchomotor tone by lung inflation in asthmatic and nonasthmatic subjects. J. Appl. Physiol. 1981, 89: 1079-1086.
34. Brusasco V., Crimi E., Barisone G. et al.: Airway responsiveness to metacholine: effects of deep inhalations and airway inflammation. J. Appl. Physiol. 1999, 87: 567-573.
35. Kapsali T., Permutt S., Laube B. et al.: Potent bronchoprotective effect of deep inspiration and its absence in asthma. J. Appl. Physiol. 2000, 89: 711-720.
36. Cockcroft D.W., Davis B.E., Todd D.C. et al.: Methacholine challenge. Comparison of two methods. Chest 2005, 127: 839-844.
37. Cockcroft D.W., Davis B.E.: The bronchoprotective effect of inhaling metacholine by using total lung capacity inspirations has a marked influence on the interpretation of the test result. J. Allergy Clin. Immunol. 2006, 117: 1244-1248.
38. Prieto L., Lopez V., Llusar R. et al.: Differences in response to methacholine between the tidal breathing and dosimeter methods. Influence of the dose of bronchoconstrictor agent delivered to the mouth. Chest 2008, 134: 699-703.
39. Todd D.C., Davis B.E., Hurst T.S. et al.: Dosimeter methacholine challenge: comparison of maximal versus submaximal inhalations. J. Allergy Clin. Immunol. 2004, 114: 517-519.
40. Juniper E.F., Syty-Golda M., Hargreave F.E.: Histamine inhalation tests: inhalation of aerosol via facemask versus a valve box with mouthpiece. Thorax 1984, 39: 556-557.
41. Hurst T.S., Cockcroft D.W., Hannah V.D. et al.: A comparison of 2 methods of continuous aerosol administration during metacholine challenge testing. Respir. Care 2006, 51: 46-48.
42. Parker A.L.: Airway reactivity is a determinant of bronchodilator responsiveness after metacholine-induced bronchoconstriction. J. Asthma 2004, 41: 671-677.
43. Coates A.L., Leung K., Dell S.D.: Developing alternative delivery systems for methacholine challenge test. J. Aerosol. Med. Pulm. Del. 2014, 27: 66-70.
44. Siergiejko Z., Świebocka E.: Czy chory na astmę może mieć prawidłową reaktywność oskrzeli? Alergia 2010, 4: 47-49.
45. [online: http://www.provocholine.com/Resources/SSM-slides-SEPT8-2010-FINAL.pdf].
2. Sterk P.J., Bel E.H.: Bronchial hyperresponsiveness: The need a distinction between hypersensitivity and excessive airway narrowing. Eur. Respir. J. 1989, 2: 267-274.
3. Siergiejko Z.: Farmakologiczna modulacja reaktywności oskrzeli. Rozprawa habilitacyjna, Uniwersytet Medyczny w Białymstoku, Białystok 1997.
4. Ulotka handlowa Provocholiny®, Methapharm Inc.
5. Townley R.G., Ryo U.Y., Kolotkin B.M. et al.: Bronchial sensitivity to methacholine in current and former asthmatic and allergic rhinitis patients and control subjects. J. Allergy Clin. Immunol. 1975, 56: 429-442.
6. Curry J.J.: Comparative action of acethyl-beta-methyl choline and histamine on the respiratory tract in normals, patients with hay fever, and subjects with bronchial asthma. J. Clin. Invest. 1947, 26(3): 430-438.
7. Curry J.J.: The action of histamine on the respiratory tract in normal and asthmatic subjects. J. Clin. Invest. 1946, 25: 785.
8. Tiffenau R., Pinelli A.: Air circulant et air captif dans i’exploration de la fonction ventilatrice pulmonaire. Paris Med. 1947, 37: 624-628.
9. Yernault J.C.: The birth and development of the forced expiratory manoevre: a tribute to Robert Tiffenau (1910-1961). Eur. Respir. J. 1997, 10: 2704-2710.
10. Felarca A.B., Itkin I.H.: Studies with the quantitative-inhalation challenge technique. I. Curve of dose response to acetyl-beta-methylcholine in patients with asthma of known and unknown origin, hay fever subjects, and nonatopic volunteers. J. Allergy 1966, 37(4): 223-235.
11. Droszcz W., Ajewski Z.: The value of bronchodilatatory test and acetylcholine provocation test in the diagnosis of bronchospastic conditions. Gruźlica 1965, 33: 287-293.
12. Aas K.: Bronchial provocation tests in asthma. Arch. Dis. Child. 1970, 45: 221-228.
13. Spector S.L., Farr R.S.: A comparison of methacholine and histamine inhalations in asthmatics. J. Allergy Clin. Immunol. 1975, 56: 308-316.
14. Chai H., Farr R.S., Froehlich L.A. et al.: Standardization of bronchial inhalation challenge procedures. J. Allergy Clin. Immunol. 1975, 56: 323-327.
15. Fish J.E., Rosenthal R.R., Batra G. et al.: Am. Rev. Respir. Dis. 1976, 113: 579-586.
16. Klaustermeyer W.B., Hale F.C., Prescott E.J.: Analysis of the methacholine response in bronchial asthma. Ann. Allergy 1979, 43: 237-240.
17. Guidelines for standardization of bronchial challenges with (nonspecific) bronchoconstriction agents. Eiser N.M., Kerrebijn K.F., Quanjer P.H. (red.). Bull. Eur. Physiopathol. Respir. 1983, 19: 495-514.
18. Cockcroft D.W., Berscheid B.A.: Effect of pH on bronchial response to inhaled histamine. Thorax 1982, 37: 133-136.
19. Cockcroft D.W., Berscheid B.A.: Slope of the dose-response curve: usefulness in assessing bronchial responses to inhaled histamine. Thorax 1983, 38: 55-61.
20. Cockcroft D.W., Berscheid B.A., Murdock K.Y.: Measurement of responsiveness to inhaled histamine using FEV1: comparison of PC20 and treshold. Thorax 1983, 38: 523-526.
21. Ryan G., Dolovich M.B., Obminski G. et al.: Standardization of inhalation provocation tests: influence of nebulizer output, particle size, and method of inhalation. J. Allergy Clin. Immunol. 1981, 67(2): 156-161.
22. Ryan G., Dolovich M.B., Roberts F.S. et al.: Standardization of inhalation provocation tests: two techniques of aerosol generation and inhalation compared. Am. Rev. Respir. Dis. 1981, 123: 195-199.
23. Cockcroft D.W., Berscheid B.A.: Standardization of inhalation provocation tests. Dose vs concentration of histamine. Chest 1982, 82(5): 572-575.
24. Rutkowski R., Siergiejko Z., Hofman J. et al.: Wpływ pirenzepiny na reaktywność oskrzeli ocenianą testem metacholinowym metodą ślepej próby u chorych na dychawicę oskrzelową. Pneum. Pol. 1989, LVII: 10-12.
25. Rosenthal R.R.: Metodologies of aerosol delivery. W: Provocation testing in clinical practice. Spector S.L. (red.). Marcel Dekker, New York 1995: 215-229.
26. Shapiro G.G., Simon R.A., for the Amercican Academy of Allergy and Immunology Bronchoprovocation Commmitte: Bronchoprovocation committee report. J. Allergy Clin. Immunol. 1992, 89: 775-778.
27. Sterk P.J., Fabri L.M., Quanjer P.H. et al.: Airway responsiveness: standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Statement of the European Respiratory Society. Eur. Respir. J. 1993, 6(Suppl.16): 53-83.
28. Juniper E.F., Cockcroft D.W., Hargreave F.E.: Tidal breathing method. In histamine and methacholine inhalation tests: Laboratory procedure and standardization. Wyd. II. Astra Draco AB, 1994, Lund, Szwecja.
29. [online: http://www.ginasthma.org].
30. Anderson S.D., Brannan J., Spring J. et al.: A new method for bronchial provocation testing in asthmatic subject using a dry powder mannitol. Am. J. Respir. Crit. Care Med. 1997, 156: 758-765.
31. Anderson S.D., Charlton B., Weiler J.M. et al.: A305 Study Group comparison of mannitol and methacholine to predict excercise-induced bronchoconstriction and clinical diagnosis of asthma. Respir. Res. 2009, 10: 4.
32. Świebocka E.M., Siergiejko G., Siergiejko Z.: Mannitol challenge does not confirm bronchial hyperreactivity in some histamine-responsive asthmatic children. J. Asthma 2012, 48: 817-821.
33. Fish J.E., Ankin M.G., Kelly J.F. et al.: Regulation of bronchomotor tone by lung inflation in asthmatic and nonasthmatic subjects. J. Appl. Physiol. 1981, 89: 1079-1086.
34. Brusasco V., Crimi E., Barisone G. et al.: Airway responsiveness to metacholine: effects of deep inhalations and airway inflammation. J. Appl. Physiol. 1999, 87: 567-573.
35. Kapsali T., Permutt S., Laube B. et al.: Potent bronchoprotective effect of deep inspiration and its absence in asthma. J. Appl. Physiol. 2000, 89: 711-720.
36. Cockcroft D.W., Davis B.E., Todd D.C. et al.: Methacholine challenge. Comparison of two methods. Chest 2005, 127: 839-844.
37. Cockcroft D.W., Davis B.E.: The bronchoprotective effect of inhaling metacholine by using total lung capacity inspirations has a marked influence on the interpretation of the test result. J. Allergy Clin. Immunol. 2006, 117: 1244-1248.
38. Prieto L., Lopez V., Llusar R. et al.: Differences in response to methacholine between the tidal breathing and dosimeter methods. Influence of the dose of bronchoconstrictor agent delivered to the mouth. Chest 2008, 134: 699-703.
39. Todd D.C., Davis B.E., Hurst T.S. et al.: Dosimeter methacholine challenge: comparison of maximal versus submaximal inhalations. J. Allergy Clin. Immunol. 2004, 114: 517-519.
40. Juniper E.F., Syty-Golda M., Hargreave F.E.: Histamine inhalation tests: inhalation of aerosol via facemask versus a valve box with mouthpiece. Thorax 1984, 39: 556-557.
41. Hurst T.S., Cockcroft D.W., Hannah V.D. et al.: A comparison of 2 methods of continuous aerosol administration during metacholine challenge testing. Respir. Care 2006, 51: 46-48.
42. Parker A.L.: Airway reactivity is a determinant of bronchodilator responsiveness after metacholine-induced bronchoconstriction. J. Asthma 2004, 41: 671-677.
43. Coates A.L., Leung K., Dell S.D.: Developing alternative delivery systems for methacholine challenge test. J. Aerosol. Med. Pulm. Del. 2014, 27: 66-70.
44. Siergiejko Z., Świebocka E.: Czy chory na astmę może mieć prawidłową reaktywność oskrzeli? Alergia 2010, 4: 47-49.
45. [online: http://www.provocholine.com/Resources/SSM-slides-SEPT8-2010-FINAL.pdf].