The bronchial provocation test (BPT) is a widely utilized method for assessing airway hyperreactivity (AHR) and serves as a crucial tool for both the diagnosis and therapeutic evaluation of asthma. Despite its significance, BPT is often underutilized outside the field of respiratory medicine.

This study aims to analyze the application of BPT across various hospital departments, as well as the BPT positive rate and AHR severity grades, using real-world data from a large sample of BPT cases.

BPT reports from the First Affiliated Hospital of Guangzhou Medical University, spanning March 2017 to April 2022, were systematically collected for analysis. Reports pertaining to children (under 18 years of age) and those lacking critical indicators were excluded from the study. The analysis focused on the distribution of BPT applications across various departments, the rate of positive BPT results, and the classification of clinical diagnoses. Positive BPT data were categorized into two groups: those positive prior to methacholine inhalation and those positive post-inhalation. The former group was designated as the "very severe" category, while the latter was further subdivided into "very mild" "mild" "moderate" and "severe" categories based on PD₂₀ values. Comparative analyses of age, height, weight, and baseline lung function indices were conducted across these groups. Additionally, multivariate Logistic regression analysis was employed to identify risk factors associated with positive BPT outcomes.

In this study, a total of 24 034 BPT reports were analyzed. The distribution of report outcomes was as follows: 27.91% were positive, 67.83% were negative, and 4.22% were suspected positive. Additionally, 8 cases did not complete the test. The internal and surgical BPT reports constituted 86.50% and 3.07% of the total, respectively, with corresponding positive rates of 28.30% and 18.70%. The study included only 2 gynecological patients, of whom 1 tested positive. Significant differences were observed in age, body weight, forced expiratory volume in the first second (FEV₁), percentage of predicted FEV₁ (FEV₁%pred), forced vital capacity (FVC), FEV₁/FVC ratio, and percentage of predicted FEV₁/FVC (FEV₁/FVC%pred) among the BPT positive groups (P< 0.05). Notably, FEV₁, FEV₁%pred, FEV₁/FVC, and FEV₁/FVC%pred values decreased progressively with increasing severity of AHR (P< 0.05). Multivariate Logistic regression analysis identified several risk factors for positive BPT results, including age over 40 years, female gender, body mass index (BMI) ≥24 kg/m², clinical diagnosis of asthma, FEV₁%pred < 80%, and FEV₁/FVC%pred < 92% (P< 0.05). A total of 51 adverse events associated with BPT were recorded, all of which were classified as very mild or mild. Among these, 8 cases were unable to complete the test due to intolerance.

BPT remains the gold standard for the rapid clinical diagnosis of AHR, offering significant value for clinical guidance. The positive rate of BPT in patients with suspected AHR is high not only in the respiratory department but also among other medical departments, warranting increased attention to BPT. Particular vigilance is advised for patients with low baseline FEV₁ and FEV₁/FVC, especially in females, people over 40 years old or with a high BMI. BPT is generally considered safe, but it is crucial to closely monitor changes in FEV₁ and any adverse reactions during provocation tests.

支气管激发试验（BPT）是验证气道高反应性（AHR）常用的方法，也是哮喘诊断和疗效评估的重要手段之一。然而，除呼吸内科外的其他科室对于支气管激发试验（BPT）的重视程度不够。

基于真实世界大样本支气管激发试验数据，对医院内不同科室BPT的开展情况、检查阳性率以及AHR分级等临床测量指标进行分析。

回顾性收集2017年3月—2022年4月广州医科大学附属第一医院肺功能室的BPT报告，排除儿童（<18岁）和缺失重要指标的报告。统计各临床科室的BPT申请数量、阳性率及临床诊断分类，将BPT阳性数据分为乙酰甲胆碱吸入前阳性和乙酰甲胆碱吸入后阳性，前者为极重度组，后者根据第1秒用力呼气容积（FEV₁）较基础值下降20%时的累积乙酰甲胆碱剂量（PD₂₀）分为极轻度、轻度、中度、重度组，比较各组间年龄、身高、体重及基础肺功能指标方面的差异。采用多因素Logistic回归分析探讨BPT阳性的危险因素。

共纳入24 034例患者的BPT报告，其中，阳性、阴性、可疑阳性的报告发生率分别为27.91%、67.83%和4.22%，8例未完成试验。就诊于内、外科的报告发生率分别为86.50%、3.07%，阳性率分别为28.30%、18.70%，妇科患者仅有2例纳入本研究，其中1例阳性。BPT阳性的各组年龄、体重、FEV₁、FEV₁占预计值百分比（FEV₁%pred）、用力呼气容积（FVC）、FEV₁/FVC、FEV₁/FVC占预计值百分比（FEV₁/FVC%pred）比较，差异有统计学意义（P<0.05）。其中，FEV₁、FEV₁%pred、FEV₁/FVC、FEV₁/FVC%pred均随着AHR等级增高而逐渐降低（P<0.05）。多因素Logistic回归分析结果显示，年龄≥40岁、女性、BMI≥24、临床诊断哮喘、FEV₁%pred<80%、FEV₁/FVC%pred<92%是BPT阳性的危险因素（P<0.05）。BPT的不良反应事件共51例（0.21%），其中8例因不能耐受而终止试验。不良反应均为极轻度或轻度。

支气管激发试验是辅助临床快速诊断气道高反应性的"金标准"，对临床指导价值重大，除呼吸科常用外，其他内科和外科的疑似存在AHR患者激发试验阳性检出率也较高，应加强对BPT的重视程度。对于基础FEV₁、FEV₁/FVC等偏低的患者，尤其是女性、40岁以上和高BMI人群，要警惕AHR可能。BPT总体上有良好的安全性，但在进行激发试验时，也应密切关注FEV₁变化和不良反应的发生。