Challenging the two-minute tidal breathing challenge test

Anne J. Lexmond*, Paul Hagedoorn, Henderik W. Frijlink, Anne H. de Boer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

11 Citations (Scopus)


BACKGROUND: In the adenosine 5'-monophosphate (AMP) bronchial challenge test, AMP is usually administered according to dosing protocols for methacholine. We investigated whether the 2-min tidal breathing challenge test for methacholine is applicable to AMP. Parameters known to affect nebulizer output were studied. Our aim was to determine whether control of additional parameters is needed for currently standardized protocols.

METHODS: The study was performed with the Sidestream nebulizer from the APS Pro Aerosol Provocation System (CareFusion Respiratory). The effects of AMP concentration, jet pressure, and suction flow rate on nebulizer output rate and aerosol droplet size distribution were determined.

RESULTS: The volume median diameter for water increased from 5.10 μm to 8.49 μm when the jet pressure was reduced to obtain the prescribed output rate of 0.13 mL/min. The output rate was increased when a suction flow rate was used to remove the aerosol. Increasing the AMP concentration resulted in smaller droplets and a lower output rate when a suction flow was applied.

CONCLUSIONS: The effects of AMP concentration on nebulizer performance may result in changes in the administered dose and site of deposition of AMP at dose escalation. All of the investigated parameters influence nebulizer performance, hence the outcome of a bronchial challenge test. Therefore, these parameters should not only be specified in challenge testing, but be actively controlled as well.

Original languageEnglish
Pages (from-to)380-386
Number of pages7
JournalJournal of aerosol medicine and pulmonary drug delivery
Issue number6
Publication statusPublished - Dec-2013


  • Adenosine Monophosphate
  • Administration, Inhalation
  • Aerosols
  • Bronchial Hyperreactivity
  • Bronchial Provocation Tests
  • Bronchoconstriction
  • Bronchoconstrictor Agents
  • Dose-Response Relationship, Drug
  • Equipment Design
  • Humans
  • Methacholine Chloride
  • Nebulizers and Vaporizers
  • Particle Size
  • Predictive Value of Tests
  • Pressure
  • Time Factors

Cite this