Bronchial Challenges

Conclusions

It is obvious that challenges of various types, those resulting in bronchoconstriction, those resulting in bronchodilation, and those that prevent bronchoconstriction without producing bronchodilation (cromolyn, as an example) should be part and parcel of the evaluation of the asthmatic. There is no better way than defining cause and effect than providing the patient with a procedure that will demonstrate a significant change in bronchial hyperreactivity when evaluated by challenges, be they inhaled formats, ingested formats, or exposure formats for those individuals who have hyperreactive airways. These challenges (delineated throughout this paper), under exacting research conditions, can be done in an office, provided that the office is equipped with the means to deliver the challenge to the lungs by inhalation, intake of food, exposure in the workplace, or by the taking of certain medications (aspirin is an example). The studies discussed previously indicate the variety of mechanisms providing these challenges, with control subjects and pertinent apparatus to define the pulmonary physiology at any point in time. However, challenges are not without their risks. This should be clearly understood before a challenge is undertaken, be it by inhalation or by ingestion. In the same manner, the challenges directed toward reducing the bronchial hyperreactivity are equally important. Adequate delivery systems and accurate measuring devices are available.