From the Guidelines
Bronchodilator reversibility and bronchial provocation testing are two distinct methods used in diagnosing asthma, with the primary difference being that bronchodilator reversibility assesses the response to a bronchodilator, whereas bronchial provocation testing evaluates the airway response to a provocative stimulus.
Key Differences
- Bronchodilator reversibility is determined by an increase in FEV1 of >200 mL and 12% from baseline measure after inhalation of a short-acting beta-2 agonist (SABA) 1, and is used to establish a diagnosis of asthma.
- Bronchial provocation testing, on the other hand, involves the use of a provocative stimulus, such as methacholine or histamine, to induce airway narrowing and assess bronchial hyperresponsiveness 1.
Diagnostic Value
- Bronchodilator reversibility is a key indicator of asthma, as it demonstrates the presence of reversible airflow obstruction 1.
- Bronchial provocation testing is used to assess airway hyperresponsiveness, which is a characteristic feature of asthma, but can also be present in other conditions, such as chronic obstructive pulmonary disease (COPD) 1.
Clinical Practice
- Bronchodilator reversibility is a recommended method for establishing a diagnosis of asthma, and is widely used in clinical practice 1.
- Bronchial provocation testing is typically used in research settings or in specialized clinics, and is not commonly used in primary care settings due to safety concerns and the need for specialized equipment and training 1.
From the Research
Difference between Bronchodilator Reversibility and Bronchial Provocation Testing
- Bronchodilator reversibility testing measures the response of the airways to a bronchodilator, such as salbutamol, and is used to diagnose and monitor asthma and COPD 2, 3.
- Bronchial provocation testing, also known as methacholine challenge, measures the airway responsiveness to a stimulus, such as methacholine, and is used to diagnose asthma 4, 5.
Key Differences
- Bronchodilator reversibility testing is used to assess the degree of airway obstruction and the response to treatment, while bronchial provocation testing is used to assess the degree of airway hyperresponsiveness 4, 5.
- Bronchodilator reversibility testing is more commonly used in clinical practice, while bronchial provocation testing is more commonly used in research settings 4, 5.
- The results of bronchodilator reversibility testing and bronchial provocation testing do not always correlate, and they may identify different populations of asthmatics 5.
Diagnostic Value
- Bronchodilator reversibility testing has limited value in distinguishing asthma from COPD, as both conditions can exhibit reversibility 2, 3.
- Bronchial provocation testing is more sensitive and specific for diagnosing asthma, but it is not always positive in patients with asthma 4, 5.
- The combination of bronchodilator reversibility testing and bronchial provocation testing may provide more accurate diagnostic information than either test alone 5.
Clinical Implications
- The choice of test depends on the clinical context and the specific diagnostic question being asked 4, 5.
- Bronchodilator reversibility testing is useful for monitoring treatment response and adjusting therapy, while bronchial provocation testing is useful for diagnosing asthma and assessing airway hyperresponsiveness 4, 5.
- A uniform nomenclature and consistent interpretation of test results are essential for accurate diagnosis and treatment of obstructive lung diseases 6.