Diagnostic and therapeutic value of airway challenges in asthma.

Airway challenges are of value in the assessment of asthma. Direct challenges (histamine and methacholine) are highly sensitive for clinically current symptomatic asthma and particularly useful to exclude current asthma when they are negative. Indirect challenges (exercise, eucapnic voluntary hyperventilation, adenosine monophosphate, hypertonic saline, mannitol) are more specific but very insensitive for clinical asthma. They are of particular value to confirm asthma and to differentiate asthma from other airway diseases, such as chronic airflow limitation. The indirect stimuli are the challenges of choice for evaluating exercise-induced bronchoconstriction.