Methol Challenge Testing Basics

Overview

• Methol Challenge Testing: Also known as bronchial challenge testing, used to assess Airway Hyperresponsiveness (AHR).
• AHR Significance: Common in asthma, other diseases with airway inflammation or obstruction, and athletes (especially in winter sports).

2017 Standards Update

• Publishing Bodies: Updated by the European Respiratory Society (ERS) and the American Thoracic Society (ATS).
• Publication Note: ATS funding ran out, but the standards are endorsed by ATS.

Key Changes in 2017 Standards

1. Provocative Dose (PD20) vs. Provocative Concentration (PC20):
   • PD20: Delivered dose causing a 20% fall in F1, allows for comparable results.
   • Replaces the use of PC20.
2. Delivery Devices:
   • Options: Dosimeter or handheld nebulizer.
   • Handheld nebulizers are easier and more cost-effective.
   • Essential for nebulizers to have published specifications for accurate dose calculation (output in mg/min and droplet size <5 micrometers).
3. Inhalation Protocol: New guidelines for inhalation methods.

Nebulizer Specifications

• Only three nebulizers with published specifications:
  • English WR Aro Eclipse
  • Band 2
  • Hudson RCI Micromist

Creating a Methol Protocol

• Software Requirement: Must have bronchial provocation software option installed.
• Verification: Check in the Ascent software under the help icon or licensing tab.
• Protocol Customization:
  • Based on the nebulizer's specifications and designed to fit hospital needs.
  • Four recommended protocols by MGC Diagnostics, but others can be created similarly.

Steps to Create a Protocol

1. Enter Admin Section: Access through the main menu if permissions allow.
2. Use PF Protocol Editor: Shows default and user-created protocols.
3. Add New Protocol:
   • Enter protocol name.
   • Select challenge agent (e.g., methol).
   • Set optional timer settings for FEC maneuver timing.

Protocol Timer Settings

• Timers Suggested:
  • 60 seconds for nebulizer.
  • 30 seconds to prepare for first effort.
  • 60 seconds for the first effort.
  • 90 seconds for the second effort.

Indicators and Stages

• Positive Indicator: Drop in FEV1 by 20% or greater signals a positive test.
• Airway Resistance: Can be added as a secondary indicator.
• Stage Configuration:
  • Example: Hudson RCI Micromist with eight stages.
  • Customize stage labels for reports.

Finalizing Protocol

• Save Changes: Ensure to save after configuration.
• Testing: Choose the newly created protocol and follow through stages.

Additional Information

• For further assistance, contact MGC Diagnostics technical support.