@article{9effa4f47e624b389d7ed8fcc614ec6a,
title = "ERS technical standard on bronchial challenge testing: Pathophysiology and methodology of indirect airway challenge testing",
abstract = "Recently, this international task force reported the general considerations for bronchial challenge testing and the performance of the methacholine challenge test, a {"}direct{"} airway challenge test. Here, the task force provides an updated description of the pathophysiology and the methods to conduct indirect challenge tests. Because indirect challenge tests trigger airway narrowing through the activation of endogenous pathways that are involved in asthma, indirect challenge tests tend to be specific for asthma and reveal much about the biology of asthma, but may be less sensitive than direct tests for the detection of airway hyperresponsiveness. We provide recommendations for the conduct and interpretation of hyperpnoea challenge tests such as dry air exercise challenge and eucapnic voluntary hyperpnoea that provide a single strong stimulus for airway narrowing. This technical standard expands the recommendations to additional indirect tests such as hypertonic saline, mannitol and adenosine challenge that are incremental tests, but still retain characteristics of other indirect challenges. Assessment of airway hyperresponsiveness, with direct and indirect tests, are valuable tools to understand and to monitor airway function and to characterise the underlying asthma phenotype to guide therapy. The tests should be interpreted within the context of the clinical features of asthma.",
author = "Hallstrand, {Teal S.} and Leuppi, {Joerg D.} and Guy Joos and Hall, {Graham L.} and Carlsen, {Kai H{\aa}kon} and Kaminsky, {David A.} and Coates, {Allan L.} and Cockcroft, {Donald W.} and Culver, {Bruce H.} and Zuzana Diamant and Gauvreau, {Gail M.} and Ildiko Horvath and {De Jongh}, {Frans H.C.} and Laube, {Beth L.} and Sterk, {Peter J.} and Jack Wanger",
note = "Funding Information: Conflict of interest: T.S. Hallstrand has nothing to disclose. J.D. Leuppi has nothing to disclose. G. Joos reports grants and personal fees for advisory board work and lecturing from AstraZeneca and Novartis, grants from Boehringer Ingelheim and Chiesi, grants and personal fees for advisory board work from GlaxoSmithKline, and personal fees for lecturing from Teva, outside the submitted work. G.L. Hall has nothing to disclose. K.H. Carlsen has nothing to disclose. D.A. Kaminsky has received honoraria for teaching at an annual Cardiorespiratory Diagnostics Course from MGC Diagnostics, Inc., outside the submitted work. A.L. Coates has nothing to disclose. D.W. Cockcroft is a member of a medical advisory board for Methapharm, as has received products for research purposes from Aerogen and Pharmaxis, outside the submitted work. B.H. Culver has nothing to disclose. Z. Diamant reports personal fees from Aerocrine, ALK, Aquilon, AstraZeneca, Boehringer Ingelheim, Gilead, HAL Allergy, MSD and Sanofi Genzyme-Regeneron, outside the submitted work. G.M. Gauvreau has nothing to disclose. I. Horvath reports personal fees and non-financial support from AstraZeneca, Berlin-Chemie, Chiesi, Boehringer Ingelheim, Novartis, CSL Behring and Roche, personal fees from Sandoz, GSK, Sager Pharma, Affidea, Orion Pharma and Teva, and non-financial support from MSD, outside the submitted work. F.H.C. de Jongh has nothing to disclose. B.L. Laube has nothing to disclose. P.J. Sterk has nothing to disclose. J. Wanger has nothing to disclose. Publisher Copyright: Copyright {\textcopyright} ERS 2018.",
year = "2018",
doi = "10.1183/13993003.01033-2018",
language = "English (US)",
volume = "52",
journal = "European Respiratory Journal",
issn = "0903-1936",
publisher = "European Respiratory Society",
number = "5",
}