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Metered-Dose Inhaler To Deliver Methacholine in Bronchial Provocation Testing : A Pilot Study

Nicolas Roche; Fayssal El Husseini; Sylvie Labrune; Violaine Giraud; Thierry C. Chinet; Gérard J. Huchon
Author and Funding Information

From the Laboratoire de Biologie et Pharmacologie des Epithéliums Respiratoires, Université de Paris René Descartes et Service de Pneumologie, Hôpital Ambroise Paré, Boulogne, France


1998 by the American College of Chest Physicians


Chest. 1998;113(6):1684-1688. doi:10.1378/chest.113.6.1684
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Abstract

Background: Nonspecific bronchial provocation tests may be simplified by the use of hand-held devices to deliver methacholine.

Objective: To study the feasibility of using a metered-dose inhaler (MDI) to administer methacholine in bronchial provocation tests, and the ability of such a device to diagnose bronchial hyperresponsiveness (BHR) accurately.

Methods: In an open randomized crossover pilot study, we compared the provocative dose that induces a 20% fall in FEV1 (PD20 FEV1) obtained with the methacholine MDI with that obtained using a conventional nebulizer in 20 hyperresponsive and 20 nonhyperresponsive subjects. The MDI delivers 400 doses of 100 µg of methacholine, and was used via a spacer. Bronchial hyperresponsiveness (BHR) was defined as a PD20 FEV1 <2,000 µg with the conventional test using the nebulizer. The tests were performed in each subject in a randomized order, 1 to 7 days apart.

Results: Of the subjects who had a nebulizer PD20 FEV1 <2,000 µg, all but one had an MDI PD20 FEV1 <800 µg. When 800 µg was taken as the threshold for the diagnosis of BHR with the MDI test, the accuracy of this test to diagnose BHR was 97.5%, and the two tests were highly concordant for the diagnosis of BHR (Pearson χ2, 36.19; p<0.0001).

Conclusion: A hand-held device may be suitable for delivery of methacholine during bronchial provocation tests, if these results are confirmed in large samples.


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