Methacholine Challenge : Physiology, Methodology, and Clinical Interpretation - 04/08/25

Doi : 10.1016/j.ccm.2025.04.004

Imran Satia, MA, MB, BChir, MRCP, PhD ^a,^b,^⁎ , Mark Inman, MD, PhD ^a, Beth E. Davis, PhD ^c
^a Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario L8S 4L8, Canada
^b Firestone Institute for Respiratory Health, St Joseph’s Healthcare, Hamilton, Ontario L8N 4A6, Canada
^c Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 0W8, Canada

^∗Corresponding author. McMaster University Medical Centre, HSC 3U9, 1280 Main Street West, Hamilton, ON L8S 4L8.McMaster University Medical CentreHSC 3U91280 Main Street WestHamiltonONL8S 4L8

Résumé

This review article explores the methacholine challenge test (MCT), a bronchoprovocation technique used to assess airway hyperresponsiveness (AHR), a hallmark of asthma. The article begins by tracing the historical development of the MCT, including early studies that established its clinical relevance in diagnosing asthma. The physiological mechanisms underlying AHR are discussed, with emphasis on how these contribute to bronchoconstriction. The article also highlights advances in MCT methodology, clinical utility in ruling out asthma, factors that influence the interpretation of MCT results, and limitations of the test. Finally, the review suggests future directions for improving MCT.

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Keywords : Bronchial challenge, Methacholine, Asthma, Airways disease