%0 Journal Article %A Teal S. Hallstrand %A Joerg D. Leuppi %A Guy Joos %A Graham L. Hall %A Kai-Håkon Carlsen %A David A. Kaminsky %A Allan L. Coates %A Donald W. Cockcroft %A Bruce H. Culver %A Zuzana Diamant %A Gail M. Gauvreau %A Ildiko Horvath %A F. H. C. de Jongh %A Beth L. Laube %A P. J. Sterk %A Jack Wanger %T ERS Technical Standard on Bronchial Challenge Testing: Pathophysiology and Methodology of Indirect Airway Challenge Testing %D 2018 %R 10.1183/13993003.01033-2018 %J European Respiratory Journal %P 1801033 %X 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 hyperpnea challenge tests such as dry air exercise challenge and eucapnic voluntary hyperpnea 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.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Hallstrand has nothing to disclose.Conflict of interest: Dr. Leuppi has nothing to disclose.Conflict of interest: Dr. Joos reports grants and personal fees from AstraZeneca, grants from Boehringer Ingelheim, grants from Chiesi, grants and personal fees from GlaxoSmithKline, grants and personal fees from Novartis, personal fees from Teva, outside the submitted work.Conflict of interest: Dr. Hall has nothing to disclose.Conflict of interest: Dr. Kaminsky reports other from MGC Diagnostics, Inc., outside the submitted work.Conflict of interest: Dr. COCKCROFT reports other from METHAPHARM, non-financial support from AEROGEN, non-financial support from PHARMAXIS, outside the submitted work.Conflict of interest: Dr. Culver has nothing to disclose.Conflict of interest: Dr. Gauvreau has nothing to disclose.Conflict of interest: Dr. Wanger has nothing to disclose.Conflict of interest: Dr. Carlsen has nothing to disclose.Conflict of interest: Dr. Coates has nothing to disclose.Conflict of interest: Dr. de Jongh has nothing to disclose.Conflict of interest: Dr. Diamant reports personal fees from Aerocrine, personal fees from ALK, personal fees from Aquilon, personal fees from Astrazeneca, personal fees from Boehringer Ingelheim, personal fees from Gilead, personal fees from HAL Allergy, personal fees from MSD, personal fees from Sanofi Genzyme-Regeneron, outside the submitted work.Conflict of interest: Dr. Horvath reports personal fees and non-financial support from AstraZeneca, personal fees and non-financial support from Berlin-Chemie, personal fees and non-financial support from Chiesi, personal fees and non-financial support from Boehringer-Ingelheim, personal fees from GSK, personal fees and non-financial support from Novartis, personal fees and non-financial support from CSL Behring, personal fees and non-financial support from Roche, personal fees from Sandoz, personal fees from Sager Pharma, personal fees from Affidea, personal fees from Orion Pharma, personal fees from Teva, non-financial support from MSD, outside the submitted work.Conflict of interest: Dr. Laube has nothing to disclose.Conflict of interest: Dr. Sterk has nothing to disclose. %U https://erj.ersjournals.com/content/erj/early/2018/10/04/13993003.01033-2018.full.pdf