An ERS task force has published new technical standards for bronchial challenge testing, including an updated description of the pathophysiology and the methods to conduct indirect challenge tests within the context of the clinical features of asthma.
The standards, published in the European Respiratory Journal, expand upon earlier recommendations by the task force to include additional indirect tests.
Task force members conducted a vast evidence search and review of literature related to each type of indirect challenge test, including those related to exercise, eucapnic voluntary hyperpnoea and cold air challenge testing, osmotic challenge testing including hypertonic saline and mannitol challenge tests, and adenosine challenge.
A task force member with specific expertise in each area reviewed the documents for potential inclusion in the final technical standard, and a subset was then included in the final document. The standards offer recommendations on:
- Pathophysiological basis and rationale
- Indications
- Safety considerations and contraindications
- Patient preparation
- Exercise challenge testing
- Eucapnic voluntary hyperpnoea
- Cold air challenge
- Selection of the hyperpnoea challenge protocol
- Post-challenge spirometry protocol
- Positive test threshold and interpretation of hyperpnoea challenge tests
- Incremental indirect airway challenge tests