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Exercise Provocation Challenge (EPC)

This challenge is a combined breathing and exercise test. The test can help identify what type of breathing trouble you have, if any, when you exercise. A spirometry breathing test is done before and after you exercise on a treadmill. Spirometry can show how much air you can breathe in and out. It also shows how fast you can breathe in and out. The spirometry results are compared before and after you exercise to see what changes there are in your breathing.

A laryngoscopy may be scheduled after the EPC. A laryngoscopy is often done to identify if your vocal cords may be causing you to have trouble breathing with exercise.

Preparing for the Test

Please follow these directions when getting ready for this test. These medicines will affect the results of some of these tests and may need to be stopped before the testing is done. If the medicine is not stopped we may not be able to perform the test.

Stop these inhaled medicines for 7 days before your appointment:

  • Spiriva® (tiotropium)
  • Striverdi® (olodatarol)
  • Anora® (umeclidinium and vilanterol)

Stop these inhaled medicines for 48 hours before your appointment:

  • Advair® (fluticasone and salmeterol)
  • Symbicort® (budesonide and formoterol)
  • Dulera® (mometasone and formoterol)
  • Breo® (fluticasone and vilanterol)
  • Arcapta (indacerterol)
  • Serevent® (salmeterol)
  • Foradil® (formoterol)
  • Serevent® (salmeterol)
  • Tudorza® (aclidinium)
  • Brovana® (arformoterol)
  • Perforomist™ (formoterol)

Stop these inhaled medicines for 24 hours before your appointment:

  • Atrovent® (ipratropium)
  • Combivent® (albuterol and ipratropium)
  • DuoNeb® (albuterol and ipratropium)

Stop these oral medicines for 24 hours before your appointment:

  • Accolate® (zafirlukast)
  • Zyflo® (zileuton)
  • Singular® (montelukast)

Stop these inhaled medicines for 6-8 hours before your appointment:

  • Proventil HFA®
  • Ventolin HFA®
  • ProAir® (albuterol)
  • Xopenex® (levalbuterol)

Continue to take all your other medicine as you usually do.

If a laryngoscopy is scheduled at the same time, do not eat for 1 to 2 hours before the test is scheduled.

During the Test

You will do a number of breathing tests (spirometry) before and after you exercise. The clinic staff will explain what you need to do during the breathing and exercise test. Before the testing begins a sensor will be placed on your fingertip to monitor your oxygen level and heart rate.

Once ready, you will perform spirometry. After doing the breathing tests you will exercise on a treadmill. During the first 1 to 2 minutes, the speed and incline of the treadmill may be increased until the desired heart rate for your specific allergy is reached. You will then continue for 6 to 7 additional minutes (the total duration of the exercise component will not exceed 8 minutes). After the exercise is finished, you will do several breathing tests again. If needed, albuterol may be given after the challenge.

If your doctor has scheduled you for a laryngoscopy this will be done right after you exercise.

Length of the Test

The exercise testing time often takes 1½ hour. Actual exercise time does not take 1½ hours. The rest of the test period is to prepare you for the test and observe you after the test.