Challenge tests to assess airway hyperresponsiveness and efficacy of drugs used in the treatment of asthma

Bronchial provocation tests are useful to diagnose and assess severity of asthma and to follow response to treatment. The tests used include those stimuli that act ''directly'' on receptors causing contraction of airway smooth muscle, e.g., pharmacological agents, and those stimuli that act ''indirectly'' by causing release of endogenous mediators that cause the airways to narrow. These ''indirect'' stimuli include physical ones such as airway drying from hyperpnea and changes in airway osmolarity from inhaling aerosols of water and hyperosmolar saline. Indirect stimuli cause the airways to narrow in response to endogenously released substances from inflammatory cells or nerves and responses are thought to reflect the presence and severity of inflammation of asthma. Challenge with hyperosmolar saline is now being used as an indirect test because it also identifies persons with exercise-induced asthma and is appropriate to assess suitability for diving with SCUBA. Hyperosmolar challenge is also useful to assess the effect of both the acute and chronic treatment with antiinflammatory drugs. This, combined with the potential to collect inflammatory cells in sputum induced by the same stimulus should result in this challenge being more widely used, not only in the hospital laboratory but also in epidemiology and occupational asthma.