Bronchial Provocation Tests

The bronchial provocation test evaluates how sensitive the airways in your lungs are. A spirometry breathing test is done before and after you inhale a mist. One example of the mist that may be inhaled is methacholine. Spirometry can show how much air you can breathe in and out. It also shows how fast you can breathe in and out. The spirometry results are compared before and after you inhale the spray to see what changes there are in your breathing. You will be given additional information in PPS at the time of the test.

A laryngoscopy is a procedure that may be scheduled after the bronchial provocation test. A larygoscopy is often done to identify if your vocal cords may be causing you to have trouble breathing.


Preparing for the Test

Please follow these directions when getting ready for this test. These medicines will affect the results of some of these tests and need to be stopped before the testing is done. If the medicine is not stopped before the test we may not be able to complete the test. Please let your doctor know if you are not able to stop the medicine due to increased symptoms.

Stop these inhaled medicines for 7 days before your appointment:

  • Spiriva® (tiotropium)
  • Striverdi® (olodatarol)
  • Anora® (umeclidinium and vilanterol)

Stop these inhaled medicines for 48 hours before your appointment:

  • Advair® (fluticasone and salmeterol)
  • Symbicort® (budesonide and formoterol)
  • Dulera® (mometasone and formoterol)
  • Breo® (fluticasone and vilanterol)
  • Arcapta (indacerterol)
  • Serevent® (salmeterol)
  • Foradil® (formoterol)
  • Serevent® (salmeterol)
  • Tudorza® (aclidinium)
  • Brovana® (arformoterol)
  • Perforomist™ (formoterol)

Stop these inhaled medicines for 24 hours before your appointment:

  • Atrovent® (ipratropium)
  • Combivent® (albuterol and ipratropium)
  • DuoNeb® (albuterol and ipratropium)

Stop these oral medicines for 24 hours before your appointment:

  • Accolate® (zafirlukast)
  • Zyflo® (zileuton)
  • Singular® (montelukast)

Stop these inhaled medicines for 6-8 hours before your appointment:

  • Proventil HFA®
  • Ventolin HFA®
  • ProAir® (albuterol)
  • Xopenex® (levalbuterol)

Continue to take all your other medicine as you usually do.

Pregnant women or mothers who are currently breastfeeding may not perform a methacholine challenge. Please advise your ordering doctor.

Adults - If a laryngoscopy is scheduled at the same time, do not eat for 2 hours before the test is scheduled.

Children - If a laryngoscopy is scheduled at the same time, do not eat for 3 hours before the test is scheduled.


During the Test

You will do a number of breathing tests. You will be asked to inhale a spray between the breathing tests. The technician will explain what you need to do during each test. A good effort during the testing is important to get good results. The technician will coach you during each test to help you give a good effort. If you have questions during the tests, please ask the technician.

You may be asked to sit in a Plexiglass booth for some of the testing. This booth is called a body box or plethysmograph. You will do different breathing techniques, blowing into a tube, while in the booth. Each breathing technique is often repeated to make sure the test is reliable.

If your doctor has scheduled you for a laryngoscopy this will be done right after the breathing tests are completed. During the laryngoscopy a doctor will place a small fiberoptic scope in your nose. The scope is passed through your nose to the back of your throat after topical anesthesia has been applied. The movement of the vocal cords can be seen with the scope. Please do not eat 2 to 3 hours prior to the test if a laryngoscopy has been scheduled.

Learn more about what happens with methacholine, other specific agent testing, and laryngoscopies.


Length of the Test

Bronchial provocation testing often takes 1 ½ to 2 hours.


Getting to the Test

On the day of your scheduled test, report to room A310a at Pulmonary Physiology Services, (PPS), located on the 3rd floor of the May building. If you have questions please call the Pulmonary Physiology Services at 303.398.1530.

Get directions to and see a campus map of National Jewish Health.

This information has been approved by Amy Olson, MD, MSPH (November 2014).