Is methacholine challenge sufficient to rule out bronchial hyperresponsiveness in patients with suspected asthma?

Abstract

Bronchial provocation challenges may be useful for establishing a definitive diagnosis of asthma in individuals with compatible symptoms and normal pulmonary function test results. [1] National Asthma Education and Prevention ProgramExpert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol. 2007; 120: S94-S138 PubMed Google Scholar The methacholine challenge is the most commonly performed test. Because of the high sensitivity and negative predictive value of the methacholine challenge, a negative result practically excludes current asthma with reasonable certainty. [2] Cockcroft D.W. Direct challenge tests: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest. 2010; 138: 18S-24S Crossref PubMed Scopus (153) Google Scholar However, recent data show that challenges with indirect stimuli (eg, adenosine) associate better with airway inflammation [3] Manso L. Madero M.F. Ruiz-García M. Fernández-Nieto M. Sastre J. Comparison of bronchial hyperresponsiveness to methacholine and adenosine and airway inflammation markers in patients with suspected asthma. J Asthma. 2011; 48: 335-340 Crossref PubMed Scopus (12) Google Scholar and may be ideal for confirming bronchial hyperresponsiveness due to their high specificity.