bronchoprovocation

Question 1

what is bronchoprovocation used for ?

Answer 1

used to identify and charactize airway hyper-responsiveness such as occult asthma
used to quantify the severity of airway hyperactivity
occasionally used to screen patient who may be at risk from environmental or occupational exposure to toxins

Question 2

pre screening of bronchoprovocation

Answer 2

baseline spirometry is obtained to establish the pt FEV1>65-70 % predicted or 1.5 L
pt must be asymptomatic
Bronchodilators, smoking, anticholinergic, theophylline, antihistamines, corticosteroids, leukotriene modifiers, caffeine and beta blockers should be withheld prior to testing (8 – 48hrs depending on which)

Question 3

timeframe stoppage prior to testing

Answer 3

Short Acting Bronchodilators – 8hrs
Long Acting Bronchodilators – 48hrs (some centers 1 week for tiotropium)
Combination products – 48hrs
Antihistamines – 12-24hrs
Inhaled corticosteroids – These do not always need to be stopped, center dependent

Question 4

what agents are used to assess airway hyperactivity

Answer 4

• methacholine challenge
• histamine challenge
• exercise challenge
  must have a physician present to manage severe patient decompensation

Question 5

Methacholine challenge

Answer 5

methacholine chemical that increases the parasympathetic tone in bronchial smooth muscle
specifically changes in FEV1 after each dose