Asthma challenge test

[Lizzie1956]

Firstly, huge thanks to the asthma helpline for super advice in this subject. What a fab service.

Now to forum users. What’s your personal experienced this test please.

Liz x

[Lysistrata Administrator Community Ambassador]

Hi, I have had 2. The first one I believe was histamine which is a direct challenge test, done at the Brompton. It was negative, probably because they didn't stop meds for long enough beforehand. They gave me a neb afterwards and my spirometry shot up plus I felt much better, so something going on.

Second one, mannitol challenge 2 years ago (this is an indirect challenge). I ignored the vague and incorrect advice about stopping meds and looked it up myself - I found I think Papworth's advice on what to stop and when, because it varies eg montelukast directly inhibits the path being challenged so you have to stop it for 4 days to allow for it to leave the system enough.

This one was admittedly NOT fun! Stopping the meds was hard but I wanted to even though they didn't tell me to - I felt it was worth it for a conclusive result. I came in coughing and at about 66% on spirometry - the physiologist looked at me and said well I don't think it will take long to get a result thankfully. Think I got one on the second or third dose? But not the required drop in one go, more based on sequential drops because I am weird, and also bad at spirometry when struggling to breathe. I did pretty much hate that evil little inhaler, and the physiologist joked with me to blame my consultant not him every time he brought it out! He was trying very hard to get me that required drop asap so I could stop.

He then gave me some of my inhaler (I think 2-4 puffs) via spacer, waited 15 mins, did spirometry again and I was back up to where I started (actually I think he did 2 puffs then I did 2 more in the ladies' because I had read some people get a neb and 4 puffs is often standard, so I felt it was legit and would get me the best results).

I hope this is helpful! I always advise double and triple checking what to stop beforehand, because even specialist hospitals seem to give bad advice on this - what I got told was maybe appropriate for a reversibility test but didn't take into account the different mechanisms of my various drugs. With a negative result following me round for years and being told I didn't have asthma, I really wanted to give it my best shot!

I did read that if you are low in spirometry or very symptomatic on the day so that they feel it isn't safe, they won't do it. Different places have different rules on that - I think I would have been told no based on mine at some places. Many others have not if below 50% predicted FEV1 on the day or if they can see you are having problems -I don't know if I would get one now as my FEV1 has dropped.

I hope this helps. Do you know what kind you're having (eg histamine etc?)

[Lizzie1956 in reply to Lysistrata]

Thank you. It appears to be the methacoline. But as no one has yet discussed it with me - I’ve no idea why or what! But I’m only just well after 4 admissions this year so frankly, don’t feel like rocking the boat!

Liz x

[Js706]

I’ve had a histamine challenge test - I can’t say it was particularly fun but it wasn’t awful.

I wrote up about my experience of it on my blog a couple of months ago that goes into more detail:

ainteasybeingwheezy.blogspo... 😊

[Lizzie1956 in reply to Js706]

Thank you. That’s v useful to read about it. I absolutely don’t fancy it at all! They’ve never discussed it with me and it’s come out of the blue.

Liz c

[Js706 in reply to Lizzie1956]

I can imagine! I found it sounded far worse than it was from all the info available online. (Obviously I can’t say I’d recommend the experience 😂 but I was far more stressed than I needed to be, in fact managing off meds was worse than the test itself!)

If they decide to go ahead with it make sure you talk to them about your worries at the test, they adjusted the doses they used etc for me based on what I told them and always checked I was happy to continue before we did. I just wanted to crack on and get it all out of the way but pretty sure they would have given me a rest if I had felt I needed it. Also if you have it just make sure you don’t leave until you feel better, obviously they’ll give you salbutamol and check your spirometry has gone back to normal but make sure you feel recovered too (even if you just ask if they mind you sitting in the waiting room for a little bit).

And while it didn’t cause me a flare I would recommend trying to have a chilled out day afterwards without too much to do - I made sure I had the day off of uni as I didn’t know how I would react and I’m really glad I did (spirometry is tiring!!)

[Lizzie1956 in reply to Js706]

I’m waiting for hospital to call me back before making my decision.

But have to say I’m still not keen!

Liz x

[Js706 in reply to Lizzie1956]

I guess the thing is to ask what they think it will add information wise. For me it was useful because they wanted to double check it was asthma (as when well my spirometry was always really good) and to also try to work out exactly how sensitive my airways were (very! As it turns out 😂).

So if they can give a good reason as to how it will help going forwards then I would go for it, but if it’s just for the sake of it there’s nothing wrong with saying you would rather not!

[Lizzie1956 in reply to Js706]

Thank you

Liz x

[Margerita]

Hi Lizzie

If it’s the mannitol challenge test please don’t worry. I was terrified and had the patient info leaflet from Wolverhampton respiratory centre and talked to the respiratory nurses and my consultant about it beforehand. The test is done with a series of inhalation’s though a spacer. My levels dropped considerably on only the second round and the test was stopped however I felt well not tight chested or wheezy and needed no nebs just a few puffs and of a salbutamol inhaler. Everyone reacts differently but have a chat with the resp nurses mine are brilliant and hopefully they will reassure you. Good luck carole x

[Lizzie1956 in reply to Margerita]

Thanks loads.

Liz x

[EmmaF91 Community Ambassador]

Hi

I’ve had 2(ish) 😅

I had a mannitol challenge booked a couple of years ago as I had been asymptomatic on my LFT (so it showed nothing). The day of the challenge however I was very symptomatic and spiro ‘showed’ asthma so it got cancelled and turned into a LFT with reversibility.

The second one was a histamine challenge about a year later (again at a time I was asymptomatic). This one I completed, however discovered that I don’t recognise my symptoms as when I had dropped ‘enough’ for the test to be positive I was only ‘a little breathless’ on the chart. I was made to have a neb despite feeling fine, cause my spiro hadn’t fully returned to normal on just my ventolin 🙄.

To be honest my recovery from the cancelled one was worse than the one they actually carried out (but then I’m an oddball 😂). The aim tho is to ‘initiate’ the start of an attack but not to let it progress any further, so I reckon actually having an attack would take longer to recover 😅

Everyone reacts differently from it tho so allow yourself time to recover and don’t use it if you don’t need it! Hope that helps explain what I went through anyway 😅. Good luck if/as/when you have one done!

[Lizzie1956 in reply to EmmaF91]

Thank you Emma.

Liz x