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Methacholine Challenge Testing in Reserve Officer Training Corps Cadets^*

Bernard J. Roth, Lt Col, MD, FCCP; Lynn M. Hammers, MD and Thomas A. Dillard, Col, MD, FCCP

^* From the From the Pulmonary/Critical Care Service (Drs. Roth and Dillard), Department of Medicine and the Physical Examination Section (Dr. Hammers), Soldier Care Service, Madigan Army Medical Center, Tacoma, WA. Current address: Pulmonary Section, BBR5513, Medical College of Georgia, Augusta, GA 30912-3135. Current address: 806 Shetland Pl NW, Concord, NC 28027.

Correspondence to: Lt Col Bernard J Roth, MD, MCHJ-MPU Pulmonary Clinic, Madigan Army Medical Center, Tacoma, WA 98431; e-mail Bernard. Roth@NW.amedd.army.mil

Study objective: To determine the prevalence of positive results for methacholine challenge tests in asymptomatic Reserve Officer Training Corps (ROTC) cadets with no history of asthma.

Design: Prospective, blinded cohort comparison study.

Setting: Pulmonary diseases clinic in a US Army tertiary-care medical center.

Patients: One hundred three college students who were undergoing a physical examination before entering active duty. Group 1 subjects, 58 men and 5 women with an average age of 22.7 years, had no symptoms or personal history of asthma. Group 2 patients, 34 men and 6 women with an average age of 22.2 years, had a history or recent suggestive symptoms of asthma.

Interventions: Methacholine challenge testing using concentrations of 0.025, 0.25, 2.5, 10, and 25 mg/mL for a total dose of 188 inhalation units or until FEV₁ had declined by 20%.

Results: Group 2 had significantly more patients with positive results for methacholine challenge tests or reversible airflow obstruction at baseline (23 of 40 patients [57.5%]) than group 1 (8 of 63 patients [12.7%]; p < 0.05). The cadets in group 1 with positive results for methacholine challenge tests reacted with a 20% decline in FEV₁ at the following concentrations: 25 mg/mL (188 IU), 2 patients; 10 mg/mL (64 IU), 4 patients; and 2.5 mg/mL (13.8 IU), 2 patients. Using values calculated for the provocative concentration of a substance causing a 20% fall in FEV₁ and the new American Thoracic Society criteria, four patients would have borderline bronchial hyperresponsiveness (4 to 16 mg/mL) and three patients (4.8%) would have mild bronchial hyperresponsiveness (1 to 4 mg/mL).

Conclusions: Asymptomatic US Army ROTC cadets with no history of asthma have possible false-positive responses to methacholine at concentrations > 0.25 mg/mL.

Key Words: airway challenge testing • airways hyperresponsiveness • asthma • methacholine

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