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Bronchial provocation tests: the rationale for using inhaled mannitol as a test for airway hyperresponsiveness
Jörg D Leuppi1, John D Brannan, Sandra D Anderson
1Respiratory Medicine, Department of Internal Medicine, University Hospital, Basel, Switzerland. jleuppi@uhbs.ch
Swiss Medical Weekly
|June 19, 2002
Summary
Mannitol bronchial provocation tests offer a simpler, more specific method for diagnosing asthma and exercise-induced asthma. This test helps predict steroid response and guides treatment adjustments, unlike older methods.
Area of Science:
- Respiratory Medicine
- Pulmonology
- Clinical Diagnostics
Background:
- Current pharmacological tests for airway hyperresponsiveness (AHR), like histamine and methacholine, lack specificity for asthma diagnosis and cannot identify exercise-induced asthma (EIA).
- Existing AHR tests have limitations, including inability to predict inhaled steroid response, differentiate steroid doses, or guide steroid dose reduction in treated asthmatics.
- Physical stimuli bronchial provocation tests (BPTs) like exercise or hypertonic saline are effective but time-consuming and resource-intensive.
Purpose of the Study:
- To introduce and evaluate a simplified BPT using dry powder mannitol for assessing airway hyperresponsiveness.
- To determine mannitol's utility in identifying exercise-induced asthma (EIA) and predicting response to inhaled steroids.
- To assess the impact of inhaled steroid treatment on mannitol responsiveness and its potential for guiding steroid dose reduction.
Main Methods:
- A novel BPT utilizing a dry powder mannitol challenge administered via a hand-held device in increasing doses (5 mg to 40 mg).
- Evaluation of mannitol responsiveness in identifying individuals with EIA and predicting steroid responsiveness.
- Assessment of changes in mannitol responsiveness following inhaled steroid treatment and its correlation with steroid dose adjustments.
Main Results:
- Mannitol responsiveness effectively identifies individuals with EIA and those likely to respond to inhaled steroids.
- Inhaled steroid treatment reduces mannitol responsiveness, with some subjects becoming unresponsive within 6-8 weeks.
- Mannitol responsiveness can predict the risk of asthma exacerbation during steroid dose reduction (back titration).
Conclusions:
- The mannitol BPT provides a more specific and accessible method for diagnosing asthma and EIA compared to traditional agents.
- Mannitol responsiveness serves as a valuable biomarker for predicting steroid efficacy and guiding treatment adjustments in asthma management.
- This standardized mannitol challenge has the potential to become a universal standard for BPTs in various clinical settings.