Asthma: Edited by Richard BarbersProvocative challenges to help diagnose and monitor asthma: exercise, methacholine, adenosine, and mannitolAnderson, Sandra DAuthor Information Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia Correspondence to Sandra D. Anderson PhD, DSc, Department of Respiratory and Sleep Medicine, 11 West, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia Tel: +61 2 9515 6120; fax: +61 2 9515 8196; e-mail: [email protected] Current Opinion in Pulmonary Medicine: January 2008 - Volume 14 - Issue 1 - p 39-45 doi: 10.1097/MCP.0b013e3282f197f6 Buy Metrics Abstract Purpose of review To review bronchial provocations tests used in the measurement of bronchial hyperresponsiveness to help in the diagnosis of asthma. Recent findings The bronchial provocations tests reviewed include exercise, methacholine, AMP and mannitol, with reference to methodology and monitoring of treatment. Summary Methacholine is used for identifying bronchial hyperresponsiveness and to guide treatment. Exercise is used as a bronchial provocation test because demonstrating prevention of exercise-induced asthma is an indication for use of a drug. Both of these tests are being used to study tolerance to β2 agonists. There is increasing use of eucapnic voluntary hyperpnea as a surrogate bronchial provocation test for exercise to identify exercise-induced asthma, particularly in athletes. For methacholine and AMP there is concern about the different breathing patterns used to inhale these aerosols and the impact they have on the cutoff point for identifying bronchial hyperresponsiveness. A new test that uses a kit containing prepacked capsules of different doses of mannitol and a delivery device is discussed. There is increasing interest in using tests that act indirectly by release of mediators because the bronchial hyperresponsiveness itself is an indicator of the presence of inflammation. Since treatment of inflammation leads to loss of bronchial hyperresponsiveness to indirect stimuli, these tests are well suited to identify success of treatment. © 2008 Lippincott Williams & Wilkins, Inc.