Exercise Challenge Testing:
Assess hyperreactivity when and are lost from upper airways during exercise.
or is used to get HR -% of max for - minutes.
Monitor: ECG, BP and SpO2
Post exercise: Spiro is done then every minutes until reaches it's then returns to normal.
% drop in FEV1 is a test
If FEV1 drops by 10-15% administer a

Eucapnic Voluntary Hyperventilation:
Assess airway hyperreactivity by havin pt breathe at high rate of .
Removes and from upper airway
Pt breathes gas mix of % CO2, % O2, with balance .
Spirometry is performed after and every 5 minutes for minutes.
If FEV1 drops by %, the test is positive. If FEV1 does not drop after minutes, test is
Bronchodilator to reverse any bromchospasm

Mannitol Tolerance Test
Withhold SABA hrs, all other meds hrs. No
Mannitol stimulates release of that act on bronchial smooth .
Sensitive for asthma and used to disease activity and assess therapy.
powder in special inhaler. Color coded for , , , , mg doses
Full insp with 5 second hold is done with flow 60 L/min.
After seconds, do spirometry, repeat at higher doses until % drop in Fev1
% is reported
Avoid smoking for hours, avoid on day of test

MIP
Largest amount of inspiratory pressure that can be generated against an occluded airway
Manometer with flanged mouthpiece and 3 way stopcock.
Typical Value = cmH20
Pt expires to RV, occlude mouthpiece, pt inhales maximally for - seconds.
Small is built in to offset cheek movement
Assess muscles strength: Will be decreased in disease, disease involving diaphragm, chest wall or spinal deformities

MEP
Maximum positive pressure that can be generated during forced expiration against occluded airway.
Same equipment as MEP
Typically - cmH2O
Pt inhales to , airway occluded, then pt exhales forcefully

Will be decreased with disease, especially generalized weakness. Decreased with emphysema, chronic bronchitis, CF and inability to cough.

Methacholine Challenge testing
PC20
concentration used to determine if pt had methacholine challenge. The concentraion of methacholine that made pt drop % in FEV1

Prohibited Activities
Avoid any activity that may induce . Irritants, exercise, work

Methacholine Challenge
Withholding Meds
SABA withhold hrs
LABA withhold hrs
Anticholinergics withhold hrs
Combo Drugs withhold hrs
Theophyllines withhold - hrs
Cromolyn Sodium / Nedecormil withhold hrs
Antihistamines withhold- hrs
Steroids may need to be withheld
Beta Blockers may response
Caffeine withhold hrs

Methacholine Challenge Testing
Pt inhales to w/ 1-2 second pause for breaths.
Wait min then do FVC
Repeat at higher until % reduction in FEV1 occurs
Baseline determined from spiro
First dose is saline and is a
Bronchodilator is given to reverse