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:&