Bronchial Provocation Testing: The Future

Sandra D. Anderson; John D. Brannan

Disclosures

Curr Opin Allergy Clin Immunol. 2011;11(1):46-52. 

In This Article

The Future

Performing BPTs outside of a research or specialist facility will become more attractive because regulatory approval (including the Food and Drug Administration in USA) for safety and efficacy has been given for methacholine chloride and mannitol, making them more easily reimbursable and ethically acceptable to patients or parents than alternative agents. Recent studies suggest that a negative methacholine test result should not be relied upon to rule out asthma. Further, caution should be applied in labelling a person with current asthma on the basis of a positive methacholine test result, in the absence of a positive response to mannitol and or exercise. A positive methacholine test, in the presence of a negative test to mannitol or exercise, may be more indicative of airway injury/remodelling than it is of currently active asthma. Exercise testing will continue to be used to establish efficacy of new drugs for prevention of EIB. However, more attention will be given to the type and intensity of the exercise and to the natural variability of EIB when people are selected for clinical trials.[52••] EVH may become more frequently used to exclude EIB, particularly in athletes, although availability remains an issue. Mannitol will be used to confirm presence of BHR and the potential for EIB because the kit is now widely available and it comes with an inhaler device and is delivered by a single standardized protocol. The dose-response nature of the protocol and 15% cut point means that excessive falls in FEV1 sometimes occur when the other challenges are avoided. There is also likely to be benefit in using a stimulus like mannitol for the forward and back titration of inhaled steroids because the end-point of treatment is resolution of BHR to this stimulus.[40] For this aspect the reader is referred elsewhere.[18,19,32,40,53]

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