The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

The Bronchial Provocation Challenge: Meeting the ATS Guidelines

Charles G. Irvin, Ph.D., Tuesday, December 9, 1997.

In 1980 the Assembly on Allergy and Clinical Immunology of the ATS published in the ATS News a guideline for the performance of bronchial challenges, which included methacholine, histamine and antigen challenge procedures. As this document was never formally accepted by the Board of Directors of the ATS it is not widely available but is widely followed as a de facto standard. One of the virtues of this document was its practical nature. Currently, the ATS is formulating a new guideline for the performance of bronchial challenges both for research as well as clinical diagnostic settings. However, due to the current prevalence of use, only the methacholine and exercise challenge will be covered. The document is being prepared in such a way to provide all the necessary, practical information to execute these challenge procedures as well as the rationale for this type of testing.

The presentation today will cover the numerous indications and rationale for performing bronchial provocational challenges. The inclusion and exclusion criteria will be discussed in the hopes of using this type of testing more judiciously. Safety issues will be covered as those are of concern to many. The protocol of both tests will be covered in detail as there is considerable confusion about the exact procedure. In the case of the exercise challenge there is wide variability in the exercise stress protocols that are employed. As there are many new medications on the market patient preparation in regard to medication withholding will be discussed.

Controversy exists in a number of aspects of bronchial challenge, some of which include which drugs to withdraw and time of withdrawal, use of a vehicle or diluent step, need for physician presence, and use of fewer doses protocols. These and other controversies will be discussed because, as of this writing these issues have not been resolved. The participant will also gain some insight into the process by which guidelines are formulated.

AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.

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