Bronchoprovocation testing can be very dangerous—particularly for patients with a baseline airway obstruction! In this video, from our Pulmonary Function Testing Essentials course, you'll discover the absolute contraindications to bronchoprovocation testing and learn about the importance of taking safeguards when performing bronchoprovocation tests to evaluate patients with suspected asthma.
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Take a deep dive into our Pulmonary Function Testing Essentials course and learn how to apply PFT interpretation guidelines to clinical cases. You'll learn when to use spirometry in your daily clinical practice, what tests to order, and how to interpret results. Complex concepts, like lung volumes, spirometry, diffusing capacity, bronchodilator responsiveness, and obstructive and restrictive patterns, will become second nature to you once you’ve completed this course!
[00:00:00] Bronchoprovocation testing may be dangerous. The patient with baseline airway obstruction may develop life-threatening worsening bronchospasm with bronchoprovocation testing. There are a number of absolute contraindications to performing bronchoprovocation testing in any form. One, when airway obstruction is present at baseline especially if the
[00:00:30] FEV1 is less than 50% predicted. Two, a recent myocardial infarction or cerebrovascular accident that is within the last three months. And three, poorly controlled hypertension. Relative contraindications to bronchoprovocation testing include—one, reduced FEV1 but not less than 50% predicted; two, pregnancy;
[00:01:00] three, lactation; and four, use of a cholinesterase inhibitor. Of course, even when all contraindications have been avoided, there are some caveats to keep in mind. Of particular note, a recent upper respiratory tract infection may cause airway hyperreactivity for up to six weeks in otherwise normal individuals. Additionally, influenza
[00:01:30] vaccination in asthmatics may produce increased airway reactivity for up to eight weeks following immunization. Bronchodilators including caffeine need to be avoided for at least six hours prior to testing. Inhalation of cold air, hyperventilation, and exercise also need to be avoided for at least six hours prior to testing, in order to prevent induction
[00:02:00] of the previously described refractory period or development of a late response to the airway stimulus.