Methacholine challenge test: diagnostic characteristics in asthmatic patients receiving controller medications

J Allergy Clin Immunol. 2012 Jul;130(1):69-75.e6. doi: 10.1016/j.jaci.2012.02.025. Epub 2012 Apr 1.


Background: The methacholine challenge test (MCT) is commonly used to assess airway hyperresponsiveness, but the diagnostic characteristics have not been well studied in asthmatic patients receiving controller medications after the use of high-potency inhaled corticosteroids became common.

Objectives: We investigated the ability of the MCT to differentiate participants with a physician's diagnosis of asthma from nonasthmatic participants.

Methods: We conducted a cohort-control study in asthmatic participants (n= 126) who were receiving regular controller medications and nonasthmatic control participants (n= 93) to evaluate the sensitivity and specificity of the MCT.

Results: The overall sensitivity was 77% and the specificity was 96% with a threshold PC(20) (the provocative concentration of methacholine that results in a 20% drop in FEV(1)) of 8 mg/mL. The sensitivity was significantly lower in white than in African American participants (69% vs 95%, P= .015) and higher in atopic compared with nonatopic (82% vs 52%, P= .005). Increasing the PC(20) threshold from 8 to 16 mg/mL did not noticeably improve the performance characteristics of the test. African American race, presence of atopy, and lower percent predicted FEV(1) were associated with a positive test result.

Conclusions: The utility of the MCT to rule out a diagnosis of asthma depends on racial and atopic characteristics. Clinicians should take into account the reduced sensitivity of the MCT in white and nonatopic asthmatic patients when using this test for the diagnosis of asthma.

Trial registration: NCT00705341.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Aged
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / diagnosis
  • Asthma / drug therapy*
  • Bronchial Hyperreactivity / diagnosis
  • Bronchial Hyperreactivity / drug therapy
  • Bronchial Provocation Tests / methods*
  • Child
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Forced Expiratory Volume
  • Humans
  • Male
  • Methacholine Chloride*
  • Middle Aged
  • Predictive Value of Tests
  • Respiratory Function Tests
  • Sensitivity and Specificity
  • Treatment Outcome
  • Young Adult


  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents
  • Methacholine Chloride

Associated data