Bronchial Provocation Test: Get a Lung Function Challenge Test

A bronchial provocation test is a particularly useful method of diagnosing asthma in patients. This is achieved by having the patient inhale a powder called Mannitol, which simulates the process in which an asthmatic is exposed to a potential trigger for their symptoms. After a dose of Mannitol, the patient’s lung function is assessed with spirometry, in order to determine whether or not any significant changes have occurred.

 

This kind of lung challenge test is one of many that Manse Medical employs in order to diagnose asthma. If you would like to find out more about the bronchial provocation test, keep reading and we will discuss it in further detail.

How does a bronchial provocation test work?

 

It’s worth noting that the bronchial provocation test is perfectly safe to perform. Mannitol is a naturally occurring type of sugar alcohol that is used as both a sweetener and in various forms of medication.

 

In the context of the bronchial provocation test, Mannitol is inhaled by the patient because it increases osmolarity in the airways which can cause the airways to constrict, especially in patients with asthma. This helps identify airway hyperresponsiveness in potential asthmatics.

 

The accompanying spirometry test involves the patient breathing into a device called a spirometer. Typically, this involves taking a breath in as big as they can and breathing out as hard and fast as possible. A spirometry test is usually performed while seated at least 3 times and takes approximately 15-20 minutes to complete.

What diseases does a bronchial provocation test diagnose?

Bronchial provocation tests serve two functions when it comes to diagnosing respiratory disease:

  • Confirming that a patient has asthma

  • Ruling out asthma if it turns out that other respiratory tests or exams did not give a clear diagnosis

 

In the event that your airways do not react to Mannitol, it is likely that your condition is not asthma, but rather a different respiratory condition with similar symptoms. These situations include:

  • Pneumonia

  • Upper airway obstruction

  • Heart failure

  • Vocal cord dysfunction

  • Bronchopulmonary dysplasia

  • Cystic fibrosis

  • Enlarged lymph nodes

  • Lung cancer (tumours)

  • Viral infections

  • Sinus infections

  • Chronic obstructive pulmonary disease (emphysema or chronic bronchitis)

What symptoms suggest I need a bronchial provocation test?

As the previous answers suggest, bronchial provocation tests tend to revolve around the diagnosis of asthma, which informs the symptoms that necessitate a bronchial provocation test.

 

What this means is that, if you are experiencing a cough, chest tightness, shortness of breath, etc. it is likely that your respiratory specialist will suggest a bronchial provocation test to determine whether or not asthma is the reason why these symptoms have presented themselves.

 

Spirometry tests measure the amount of air you can breathe in, as well as how quickly you can exhale. If these measurements are significantly affected by exposure to Mannitol, it suggests that you are experiencing the symptoms you have due to asthma.

How do I prepare for a bronchial provocation test?

 

Like many major medical procedures, there are specific preparations that must be made for a bronchial provocation test to ensure the accuracy of its results. Of course, if you are unable to stop these medications due to increased symptoms, it is important to discuss this with your doctor.

 

The following medicines include:

  • Short/Long acting beta agonists (SABA/LABA medications)

  • Short/Long acting muscarinic agonists (SAMA/LAMA medications)

  • Inhaled corticosteroids (ICS preventers)

 

Because these medicines are inhaled (via peripherals such as an inhaler, accuhaler, turbuhaler, etc.), their use affects the airways in a way that affects the fidelity of the results of a bronchial provocation test, which is why they should be cancelled a specified period of time beforehand.

Inhaled medicines to stop 72 hours before the appointment

  • Anora (umeclidinium and vilanterol)

  • Bevespi (glycopyrrolate and formoterol)

  • Incruse (umeclidinium)

  • Seebri (glycopyrrolate)

  • Spiriva (tiotropium)

  • Stiolto (olodaterol and tiotropium)

  • Tudorza (aclidinium)

  • Utibron (indacaterol and glycopyrrolate)

  • Trelegy (fluticasone, umeclidinium and vilanterol)

Inhaled medicines to stop 48 hours before the appointment

  • Advair (fluticasone and salmeterol)

  • Breo (fluticasone and vilanterol)

  • Dulera (mometasone and formoterol)

  • Symbicort (budesonide and formoterol)

Inhaled medicines to stop 36 hours before the appointment

  • Arcapta (indacaterol)

  • Brovana (arformoterol)

  • Perforomist (formoterol)

  • Serevent (salmeterol)

  • Striverdi (olodaterol)

Inhaled medicines to stop 12 hours before the appointment

  • Atrovent (ipratropium)

  • Combivent (albuterol and ipratropium)

  • DuoNeb (albuterol and ipratropium)

Inhaled medicines to stop 6 hours before the appointment

  • ProAir HFA

  • Proventil HFA

  • Ventolin HFA (albuterol)

  • Xopenex (levalbuterol)

What other preparations should I make?

There are other steps that you can take in order to ensure that your test results are as accurate as possible. Some of these steps have specific qualifiers to them (i.e. they are for people with pre-existing conditions), while others are steps that anybody can take, regardless.

 

  • Continue to take all your other medicine as advised by your doctor.

  • Alert your doctor if you have experienced any medical problems that could affect different aspects of Mannitol; from its potency, to your body’s ability to promptly expel it. These include:

    • Angina (severe chest pain)

    • Severe cough

    • Hemoptysis (coughing up blood)

    • Infection (eg, upper and lower respiratory tract)

    • Lung disease or other breathing problems (e.g. ventilatory impairment)

    • Pneumothorax (air or gas in the chest cavity)

    • Spirometry-induced bronchoconstriction (breathing problems during a previous spirometry test)

    • Recent surgery (eg, stomach, chest, or eyes)

    • Aortic or cerebral aneurysm (heart or blood vessel problem)

    • Recent heart attack

    • Hypertension (high blood pressure)

    • Recent stroke

    • Kidney disease

  • If you are diabetic, it is recommended that you bring your glucose metre, any test strips, and a source of fast-acting glucose with you (such as glucose tablets or glucose gel). This is because exercising can drop blood sugar in patients who are taking medications to control diabetes. 

  • There are no adequate studies in women for determining infant risk when using Mannitol during breastfeeding. It is important that you advise your doctor if you are breastfeeding so that the pros and cons can be adequately weighed if you plan to undergo a bronchial provocation test.

  • If you have a laryngoscopy scheduled at the same time, it is important that you do not eat for 2 hours before your bronchial provocation test is scheduled (3 hours before if the test in question is scheduled for a child).

 

Of course, if you have any questions about your upcoming test and the precautions that you should take, it is highly recommended that you speak with your doctor. They will be able to vet any questions that you may have, while also making sure that you are completely prepared for your test.

What other respiratory tests are there?

There are other tests that a respiratory doctor might prescribe in order to conclusively diagnose any respiratory conditions in a patient. These tests achieve that result by measuring the function of the lungs in various ways, particularly how much the patient can inhale and exhale.

 

Conditions requiring respiratory testing services range from allergic disorders such as asthma and hayfever and lung diseases caused by smoking, lung infections, inflammation and lung cancer. Lastly, other diagnoses may include chronic lung infections, inflammatory reactions, and asbestos-related respiratory problems.

Spirometry

As previously mentioned, Spirometry requires the patient to breathe into a device called a spirometer. Typically, this involves taking a breath in as big as they can and breathing out as hard and fast as possible. A spirometry test is usually performed while seated at least 3 times and takes approximately 15-20 minutes to complete. 

 

If there is no need to diagnose asthma, your respiratory doctor will likely not prescribe a bronchial provocation test in which Mannitol is used. However, if you are suffering from respiratory symptoms, you still might be required to take a spirometry test in order to measure the functionality of your lungs.

DLCO Gas Transfer

Diffusing capacity of the lungs for carbon monoxide (DLCO) gas transfer is another method of testing lung functionality by having the patient take a deep breath in, hold that breath for approximately 10 seconds, and then exhaling.

 

DLCO measures the uptake of carbon monoxide during inhalation, as carbon monoxide (CO) has a high affinity for haemoglobin while following the same pathway as oxygen. Oxygen, meanwhile, has a limited uptake that is affected by cardiac uptake and total body consumption. Thus, carbon monoxide provides a more accurate reading as to the function of the lungs when measured.

Lung Volume

Lung volume testing is another commonly performed lung function test that is generally considered to be more precise than spirometry. It measures the volume of air in the lungs, including the air that remains at the end of a normal breath, by having a patient sit in an airtight chamber, known as a body box. 

 

A respiratory specialist communicates with the patient through an intercom, instructing them on how to breathe during the test. This specific type of breathing provides readings on the patient’s lung functionality that informs subsequent diagnoses. 

6 Minute Walk Tests

As the name suggests, this test has patients walking at a normal pace for six minutes, where our specialists monitor the response to any potential lung, heart and other health issues.  

Where do I go if I need a bronchial provocation test?

At Manse Medical, we provide a bronchial provocation test. Book your appointment online by selecting your preferred clinic and choose from the list of our available specialists.