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Related Experiment Video

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Symptom Assessment of Patients with Allergic Rhinitis Using an Allergen Exposure Chamber
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Mannitol and exercise challenge tests in asthmatic children.

Elin T G Kersten1, Jean M M Driessen, Julianne D van der Berg

  • 1Department of Pediatrics, Medisch Spectrum Twente, Postbus 50.000, Enschede 7500 KA, The Netherlands. elinkersten@gmail.com

Pediatric Pulmonology
|June 6, 2009
PubMed
Summary

The mannitol challenge is a useful alternative to exercise tests for identifying exercise-induced bronchoconstriction (EIB) in children with asthma. It is particularly effective for ruling out EIB, with a 91% negative predictive value.

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Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Allergy and Immunology

Background:

  • Bronchial hyperresponsiveness (BHR) is a key asthma feature.
  • Exercise provocation tests (BPTs) diagnose exercise-induced bronchoconstriction (EIB).
  • A novel osmotic BPT using dry powder mannitol has been developed.

Purpose of the Study:

  • To evaluate the clinical utility of the mannitol challenge.
  • To identify asthmatic children with EIB using mannitol challenge.
  • To compare mannitol challenge with exercise provocation tests.

Main Methods:

  • Thirty-three children (aged 9-18) with a history of EIB underwent both mannitol and exercise challenges.
  • Cross-tabulation compared responses between the two tests.
  • Correlations between post-exercise FEV1 decline and mannitol response-dose ratio (RDR) and PD15 were calculated.

Main Results:

  • A significant correlation (r=0.666, P<0.001) was found between log-transformed mannitol RDR and post-exercise fall in FEV1.
  • No significant relationship existed between log PD15 of mannitol and post-exercise fall in FEV1.
  • Children on long-acting beta-agonists (LABA) showed a higher likelihood of a positive mannitol response (P<0.05).
  • Mannitol challenge demonstrated a 69% positive and 91% negative predictive value for EIB.

Conclusions:

  • The mannitol challenge is a viable alternative to exercise provocation tests for assessing EIB in asthmatic children.
  • With a 91% negative predictive value, mannitol challenge is highly effective for excluding EIB.