Bronchoprovocation Testing

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is bronchoprovocation testing?

Bronchoprovocation testing includes several tests used to diagnose asthma. Asthma is a chronic lung disease marked by acute flare-ups of inflammation and swelling of the airways in the lungs. 

Bronchoprovocation tests measure lung function after exposure to common asthma symptom triggers. Asthma triggers used in the test include cold air, exercise, or inhaling a mist containing a substance that causes lung constriction in people with asthma. 

Bronchoprovocation testing is only one method to diagnose asthma. Discuss all the asthma-testing options with your doctor to understand which choices are right for you.  

Types of bronchoprovocation testing

The types of bronchoprovocation testing include:

  • Cold air challenge test, which measures how the lungs react to exposure to cold air

  • Exercise challenge test, which measures how the lungs react to exercise on a treadmill

  • Inhalation tests, which measure how the lungs react to exposure to substances that cause lung constriction in people with asthma. The substances are dissolved in a mist that you inhale. The substance is often methacholine. Histamine or mannitol may also be used.

Other procedures that may be performed

Bronchoprovocation tests are a type of pulmonary (lung) function test. Your doctor will likely recommend other pulmonary function tests to diagnose asthma and monitor your condition. Other pulmonary function tests include:

  • Arterial blood gas test to measure oxygen and carbon dioxide levels in the blood
  • Body plethysmography to determine how much air is present in your lungs when you take a deep breath. It also measures how much air is left in your lungs after you exhale. Bronchoprovocation tests and other pulmonary function tests can be done at the same time as a body plethysmography using the same equipment.

  • Lung diffusion capacity to measure how well oxygen moves into your blood from your lungs

  • Peak expiratory flow to measure the speed of exhaling and lung constriction. People with asthma often use this test routinely to monitor their asthma control at home.

  • Pulse oximetry to measure oxygen levels in the blood

  • Spirometry to measure the rate and the amount of air that you inhale and exhale

Why is bronchoprovocation testing used? 

Your doctor may recommend bronchoprovocation testing to help diagnose asthma if you have some or all of the following symptoms: 

  • Chest tightness

  • Persistent cough, especially at night or in the early morning

  • Shortness of breath

  • Wheezing or a high pitched whistling sound when you breathe

Not all people with these symptoms have asthma. There are other conditions that have similar symptoms. Sometimes asthma-like symptoms can occur briefly without a serious underlying disease. Bronchoprovocation testing helps determine if your symptoms are due to asthma.
Bronchoprovocation testing is generally not the first test used to diagnose your symptoms. Your doctor may perform the test when your symptoms strongly suggest asthma and other test results are unclear, such as spirometry results. Doctors also use bronchoprovocation tests to evaluate asthma-like symptoms triggered by occupational, environmental or toxic exposures.

Who performs bronchoprovocation testing?

A pulmonary function technologist supervised by a doctor usually performs bronchoprovocation testing. A pulmonary function technologist has specialized training and education to perform pulmonary function tests safely and accurately. 

The following doctors order and supervise bronchoprovocation testing:

  • Allergists and immunologists are internists or pediatricians with specialized training in the diagnosis and treatment of allergies, asthma, and immune deficiency disorders.

  • Pulmonologists are internists or pediatricians with specialized training in treating diseases and conditions of the chest, such as pneumonia, asthma, tuberculosis, emphysema, and complicated chest infections.

How is bronchoprovocation testing performed?

Bronchoprovocation testing is performed in a pulmonary function lab in a hospital or clinic setting. The procedure varies depending on the specific test. Testing takes up to two hours and generally involves these steps: 

  1. You will blow forcefully into a spirometer. A spirometer is a device that measures the rate and the amount of air inhaled and exhaled.

  2. For an exercise test, you will exercise on a treadmill. For a cold air test, you will be exposed to cold air. For an inhalation test, you will inhale a mist that contains methacholine, histamine or mannitol through a mouthpiece. A nebulizer device makes the mist by changing liquid medications or substances into an aerosol.

  3. You will blow forcefully again into a spirometer.

  4. This process will be repeated using increasing levels of exercise or cold air or increasing concentrations of methacholine.

  5. Your airways will narrow and your lung function will drop if you have asthma.

  6. You will receive a medication called a bronchodilator at the end of the test or as needed to reverse the effects of the test.

Bronchoprovocation testing may take place inside a special clear cabinet or booth. This is called a body plethysmography. This test uses an integrated computerized pulmonary function testing system. It can also perform lung diffusion capacity and other pulmonary function tests. 

Will I feel pain with bronchoprovocation testing?

Your comfort and relaxation is important and helps obtain the most accurate test results. Remember that bronchoprovocation testing is not painful. Be assured that your care team is trained to monitor your condition and recognize and reverse adverse effects, including severe lung constriction (rare).

Tell your doctor or technologist right away if you feel any effects, such as chest tightness, shortness of breath, or wheezing. 

What are the risks and potential complications of bronchoprovocation testing?  

Bronchoprovocation testing is generally safe when performed by a qualified pulmonary function technologist who is supervised by a doctor. Most people do not have side effects or breathing symptoms with bronchoprovocation testing. When symptoms appear, they are generally mild and go away after inhaling a bronchodilator medication. 

Symptoms include:

Bronchoprovocation testing rarely causes serious narrowing of the airways. Your pulmonary function technologist is trained to recognize a serious situation and treat it immediately using resuscitation equipment if needed. 
You should not have certain types of bronchoprovocation testing in the following situations:

  • You are pregnant.

  • You have had a stroke or heart attack in the past three months.

  • You have had an aortic or cerebral aneurysm.

  • You have uncontrolled high blood pressure.

Reducing your risk of complications

You can reduce the risk of certain complications by: 

  • Ensuring your doctor is aware of your complete medical history including any history of high blood pressure, aneurysms, heart attack, or stroke

  • Following activity, dietary and lifestyle restrictions and recommendations before and after your test

  • Notifying your doctor immediately if there is any chance you are pregnant or if you are nursing

  • Taking or stopping your medications exactly as directed by your doctor

  • Telling all members of your care team if you have any allergies

How do I prepare for my bronchoprovocation test?

You are an important member of your own healthcare team. The steps you take before your test can improve your comfort, reduce the risk of complications, and help obtain the most accurate test results. 

Preparation for bronchoprovocation testing varies depending on the specific test but generally includes:

  • Avoiding excessive sugar and products that contain caffeine including coffee, tea, chocolate, sodas, and energy drinks

  • Avoiding exercise and cold air the day of the test

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times. You will need to provide this information to the pulmonary function technologist and your doctor.

  • Not smoking the day of the test

  • Taking or stopping medications exactly as directed. This often includes not taking some asthma medications for a short period before the test. This includes short- and long-acting bronchodilators and allergy drugs. Your doctor will give you exact instructions for your medications and what to do if you have asthma symptoms during this time.

  • Telling your doctor and the pulmonary function lab personnel if you have symptoms of illness within a week before the test. Symptoms include fever of cold symptoms. You will likely need to reschedule the test until you feel better.

Questions to ask your doctor or pulmonary function technologist

It is common for patients to forget some of their questions during a doctor’s visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before bronchoprovocation testing and between appointments.

It is also a good idea to bring a list of questions to your appointments. Common questions include:

  • Why do I need bronchoprovocation testing? Are there other options for diagnosing my condition?

  • What are the qualifications of the pulmonary function technologist who will perform the test?

  • Is the pulmonary function technologist certified in advanced cardiac life support? What other qualified healthcare providers respond to help with resuscitation if needed?

  • How should I take my medications before and after the test?

  • How will I feel after the test? When can I return to normal activities?

  • When and how will I get my test results?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my bronchoprovocation test?

Knowing what to expect after bronchoprovocation testing can help you get back to your everyday life as soon as possible. 

How will I feel after my bronchoprovocation test?

You should be breathing normally after your bronchoprovocation test. Your pulmonary function technologist will give you a bronchodilator to reverse the effects of the test if needed. You should not have any asthma symptoms, such as wheezing, coughing, or shortness of breath, when you go home. Let your pulmonary function technologist know if you have any symptoms, even if they are mild. 

When should I call my doctor?

It is important to keep your follow-up appointments after your bronchoprovocation test. Contact your doctor for questions and concerns between appointments. Call your doctor if you have asthma symptoms that are unusual or not responding to your medications. Seek emergency medical care or call 911 if shortness of breath or other breathing problems are getting worse quickly.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 24
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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