As Dr Polk points out, methacholine challenge has been used as a research tool for many years. However, its use in the clinical laboratory has lagged.We would agree with Dr Polk that methacholine challenge is not indicated in the obstructed patient who responds to an inhaled bronchodilator such as isoproterenol or epinephrine. In the patient with normal baseline pulmonary function, bronchodilator administration does not distinguish between asthmatics and normal subjects.1 In this group of patients with unexplained respiratory symptoms, we recommend a methacholine challenge. In more than 600 studies in our laboratory we have had no bronchoconstriction requiring anything more than simple inhalation of isoproterenol.We have found the methacholine challenge to be a safe, simple, and invaluable aid in the diagnosis of obscure asthma.
Myers JR, Braman SS, Corrao WM. Methacholine Challenge-Reply. JAMA. 1982;247(3):305. doi:10.1001/jama.1982.03320280027018
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