Bronchial Provocation Tests
Bronchial provocation tests (also called challenge tests) assess how sensitive your airways are to mild irritants. They’re especially helpful when symptoms suggest asthma, but other lung tests haven't given clear answers.
What is a bronchial provocation test?
Bronchial provocation tests can also be called bronchial challenge tests, airway provocation tests or direct challenge tests. They’re used to assess the sensitivity of your airways to irritants.
During the test, you’ll inhale small, increasing doses of a mild irritant in mist or powder form. If your airways are sensitive, they may start to narrow at lower doses. Your breathing is measured between each stage to see how your lungs respond.
Your specialist might recommend a bronchial provocation test if you have symptoms such as wheezing, cough, chest tightness or breathlessness, but standard lung function tests haven’t confirmed asthma. Because asthma often involves sensitive airways, even when other tests seem normal, this test can provide a more precise diagnosis.
At Welbeck, our bronchial provocation tests are led by our physiologists in the respiratory lab outpatient clinic, within our state-of-the-art Lung Health Centre. Using advanced diagnostic technology, our team can measure even subtle changes in airway function with exceptional precision. This level of detail helps our specialists make faster, more accurate diagnoses and tailor treatment plans that lead to better symptom control and long-term respiratory health.
More information
Before your test, you’ll have a consultation with your specialist to explain the test, how to prepare for it, and answer any questions you may have.
On the day of the test, you’ll have an appointment at our outpatient clinic. The test may take up to 90 minutes from start to finish, and you’ll receive your results within 24 hours.
Before the main part of the test, your baseline lung function will be measured using spirometry. This involves taking a deep breath and then exhaling as fast and hard as you can into a simple device called a spirometer. This measures how much air you can exhale in one forced breath. If your lung function is stable and reproducible, you’ll move on to the next part of the test.
During the test:
you’ll breathe in an irritant in increasing doses using a hand-held nebuliser (a medical device that creates a fine mist)
after each dose, spirometry is repeated to see if your airways have narrowed
the test continues until the narrowing reaches a predefined threshold or the maximum dose is reached
if narrowing occurs, the test is stopped, and a bronchodilator (a medicine that opens airways) is given to reverse the effect
Following the test, our team will monitor you closely and manage any symptoms until you return to baseline breathing.
Bronchial provocation tests are considered very safe when carried out in a controlled clinical setting by experienced respiratory specialists. The main risk is temporary narrowing of the airways, which can cause:
mild wheezing
coughing
chest tightness
shortness of breath
These symptoms are expected and closely monitored. If they occur, the test is stopped straight away, and a bronchodilator (a medicine that opens the airways) is given to quickly reverse them.
More rarely, patients may experience light-headedness, dizziness, or fatigue from repeated breathing manoeuvres, but these symptoms usually settle within minutes.
Serious complications are extremely uncommon. To ensure safety, the test isn’t performed in people with severe asthma, recent heart attack, stroke, uncontrolled high blood pressure, or certain aneurysms.
At Welbeck, every bronchial provocation test is supervised by trained physiologists and reviewed by consultant respiratory specialists. Our advanced equipment, clinical protocols, and immediate access to emergency medication ensure your test is carried out safely and comfortably.
Your team will carefully explain how to prepare for your test before your appointment. This will include not using your usual inhalers or medications.
To get the best possible results, we ask that you:
don’t smoke for at least 6 hours before the test
don’t have caffeinated food or drinks (chocolate, tea, coffee, cola) at least 4 hours before the test
don’t consume alcohol for at least 4 hours before the test
don’t do any heavy exercise on the day of the test
wear loose and comfortable clothing on the day of the test
If any symptoms are triggered by the test, these will be managed quickly and effectively by your physiologist. You’ll stay in the test area and be cared for until you’ve recovered fully and your lung function has returned to your baseline. You can then leave the outpatient clinic to return home.
Your results will be available within 24 hours and will be discussed with you at a follow-up appointment with your respiratory consultant.
Please contact our Lung Health centre for pricing.
At Welbeck, our respiratory consultants are experts in their field and are dedicated to providing world-class care to every patient.
With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.
All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.
To book a bronchial provocation test, you must be referred by either your GP or a respiratory consultant following a consultation with them. Self-referrals are not accepted for this test.
If you would like to schedule a consultation with a Welbeck respiratory consultant, please get in touch to make an appointment. Your health is important to us, so we strive to offer same-day appointments whenever possible.
Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.
Our specialists
Dr Sarah ElkinRespiratory Consultant
Dr Dean CreerRespiratory Consultant
Dr Reza AbdullahConsultant Respiratory Physician
Dr Matthew HindRespiratory Physician
Dr Richard HewittRespiratory Consultant
Professor Luke HowardRespiratory Consultant
Dr Justin GarnerRespiratory Physician
Professor Peter GeorgeRespiratory Consultant
Dr Susannah BlochRespiratory Consultant
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Frequently asked questions
In most cases, bronchial provocation tests are avoided during pregnancy because of potential risks. If testing is considered essential, your consultant will review the benefits versus any risks and may suggest safer alternatives.
Spirometry measures lung function at rest and during breathing manoeuvres, but may not reveal hidden airway sensitivity. A bronchial provocation test can identify hyperreactive airways that only react under challenge. This gives deeper insight when asthma is suspected, but spirometry is normal.
Yes, most people can return to normal activities, including work or driving, shortly after the test. Occasionally, you may feel a little tired or light-headed for a short time because of the breathing exercises. If you were given a bronchodilator to reverse airway narrowing, you’ll be observed until your breathing is fully back to normal before leaving. At Welbeck, we’ll always check that you feel well and safe before you go home.
A normal test result means your airways did not show excessive narrowing during the challenge, making asthma less likely. However, there could be other reasons for ongoing symptoms such as breathlessness or coughing, including allergies, sinus issues, acid reflux, or even vocal cord problems. If you have a normal test result, your consultant may arrange further investigations to find the underlying cause of your symptoms. At Welbeck, our multidisciplinary team works closely together to make sure no possible explanation is overlooked.