in this video we will cover the basics of methol challenge testing also called bronchial challenge along with how to create and use a new methol protocol in 2017 the European respiratory Society ERS published updated technical standards for bronchial challenge testing this was actually a joint venture by the ERS and the American thoracic Society ATS however near the end of the project the ATS funding had run out and it was left in the hands of the ERS to complete even though the ERS published the standards many of the committee members were from the ATS and the standards are fully endorsed by the ATS bronchial challenge testing or Bronco provocation testing is used to assess Airway hyperresponsiveness or ahr While most commonly associated with asthma ahr is also seen in other diseases associated with Airway inflammation or obstruction and is common among athletes especially in winter sports three of the major changes with the 2017 standards have to do with provocative dose delivery devices and inhalation protocol in the past the provocative concentration or pc20 was used to define whether or not a test was positive or not this was the concentration that caused a 20% fall in the F1 from Baseline the latest standards use the provocative dose or pd20 to define a positive test the pd20 is the delivered dose causing a 20% fall in F1 the standard State the pd20 endpoint allows comparable results from different devices or protocols the latest standards state that there are two options for delivering the methine a dosimeter or handheld nebulizer previous viously a dosimeter was the device of choice a dosimeter is still an acceptable device however a handheld nebulizer is an easier and less expensive option the caveat for any nebulizer used is that the manufacturer must publish the specifications for nebulizer output in milligram per minute plus you must know the percentage of droplets that are less than 5 micrometers without these specifications you cannot calculate an accurate delivered dose for each stage of the protocol at the time of this recording there are only three nebulizers that have their specifications published they're the English WR Aro Eclipse Band 2 and the Hudson RCI micromist this video will focus on those three for creating a new protocol in order to create or edit a methine protocol you must have the bronchial provocation software option purchased and installed to verify if you have this software option installed click on the about help icon on the main Ascent screen in Ascent version 1. X click on the support tab if the software option is installed you will have a line item for bronchial provocation in a sent 2.2 and higher click on the licensing Tab and verify you have bronchial provocation listed mgc Diagnostics recommends creating a new protocol to fit your Hospital's needs based on the specifications of the nebulizer used with the information displayed previously in this video mgc recommends using one of these four protocols for methine challenge test in however other protocols can be used and are created in the same manner you may want to pause this video to review these protocols to create a new protocol in a S software click on the main menu icon in the upper right of the software and click on the admin button note that all users may not have access to the admin section of the software check with your asent software administrator to verify you have access right note depending on the version and options of a sent software the menu items in the admin section may be slightly different than is displayed here on the left hand side of the admin page click on the PF protocol editor button in the PF protocol editor screen default protocols that came with the ascent software or other protocols made by another user will be displayed to create a new protocol click on the plus sign above the list of protocols when the new protocol called dialogue box is displayed enter the name of the protocol next from the drop-down menu select the name of the challenge agent being used in this case we are selecting methine with methine selected as the challenge agent a timer dialogue box is displayed this timer is optional and can be used to help keep track of when to perform the first and second FEC maneuver after the subject has finished breathing on the nebulizer if the timer is not needed uncheck the timer box in the upper left since we are using a 1 minute nebulizer protocol enter 60 seconds for breathe through nebulizer this will display a 60-second timer to let you know when you should discontinue the nebulizer the ATS standard state that you should perform the first fvc 30 seconds after nebulization is complete for this we use 30 seconds for prepare for first effort this will display a 30-second timer to let you know when to perform the first effort for per form first effort we have 60 seconds entered this will display a 60-second timer and let you know when it has been 60 seconds from the beginning of the first effort giving a total of 90 seconds from the completion of nebulization in the perform second effort box we have entered 90 seconds this will tell you when it has been 90 seconds from the completion of nebulization and to perform the second fvc maneuver with the timer set review the positive indicator's entry by default the Fe V1 is used by a scent as the main indicator for a positive test if a 20% or greater reduction in fe1 occurs the software will display a message indicating what percent the feev one has fallen remember that you should select the effort with the largest feev one if one of the efforts did not have a 20% reduction select that effort and continue to the next stage if performing Airway resistance with your methine test you can add Airway resistance as a secondary indicator be sure to check the is active in the upper right this will make the protocol available for patient testing next we will focus on adding the various stages to the protocol in this example we will be entering the one minute protocol using the Hudson RCI micromist nebulizer there are a total of eight stages in this protocol use the plus button to add stages until there are eight next fill in the label concentration and delivered dose is shown then check the diluent box under Baseline the guide lines recommend using the diluent stage as the stage to which all subsequent efforts will be compared to the labels for each stage can be customized for your facility these will show on your methol reports be sure to keep the labels as short as possible so that they fit within the space or columns on your report once your protocol is complete be sure to click on the save button to save all of your changes your new protocol is now ready to use for the next methine challenge test when you enter patient information on the patient visit screen go to the drop- down menu for protocol and select the methine protocol you created when you go to the test screen your methine protocol with all of the appropriate stages is ready for you to use complete testing at each stage before selecting the next stage in your protocol continue through each stage until you have a 20% or greater reduction in F1 or all of the stages have been completed thank you for watching this video for more information on methine challenge testing please contact our technical support department at 1 1800 333 4137 or email mgc diagnostics at support mgc diagnostics.com