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Mannitol dry powder challenge in comparison with exercise testing in children
Juerg Barben1, Claudia E Kuehni, Marie-Pierre F Strippoli
1Division of Paediatric Pulmonology, Children's Hospital, St. Gallen, Switzerland. juerg.barben@kispisg.ch
Insights
The mannitol dry powder (MDP) challenge is a feasible and suitable alternative for bronchial provocation testing in children. This indirect test showed good agreement with exercise testing for diagnosing asthma in pediatric patients.
Area of Science:
- Pediatric Respiratory Medicine
- Clinical Immunology
- Pulmonary Function Testing
Background:
- Mannitol dry powder (MDP) challenge is an established indirect bronchial provocation test in adults.
- Its utility and validation in pediatric populations are not well-established.
- Asthma diagnosis in children often relies on various provocative tests.
Purpose of the Study:
- To compare the feasibility, validity, and clinical significance of the MDP challenge against exercise testing in children.
- To assess the agreement and predictive values of MDP challenge for exercise-induced bronchoconstriction.
- To determine the suitability of MDP challenge as a diagnostic tool in pediatric asthma evaluation.
Main Methods:
- A cohort of 99 children (aged 6-16 years) with suspected asthma underwent standardized exercise testing followed by an MDP challenge.
- Agreement between tests was analyzed using Cohen's kappa and receiver operating characteristic (ROC) curves.
- Feasibility, side effects, and duration of both challenge tests were recorded.
Main Results:
- The MDP challenge was well-accepted, shorter in duration, and had fewer side effects than exercise testing.
- The MDP challenge was positive in 29% of children, while exercise testing was positive in 21%.
- Both tests demonstrated moderate agreement (κ = 0.58), with an area under the ROC curve of 0.83 for the MDP challenge.
Conclusions:
- The mannitol dry powder challenge test is feasible and well-tolerated in children.
- It serves as a suitable alternative to exercise testing for bronchial challenge in pediatric populations.
- MDP challenge demonstrates good validity for identifying exercise-induced bronchoconstriction.
Rationale:
Mannitol dry powder (MDP) challenge is an indirect bronchial provocation test, which is well studied in adults but not established for children.
Objective:
We compared feasibility, validity, and clinical significance of MDP challenge with exercise testing in children in a clinical setting.
Methods:
Children aged 6-16 years, referred to two respiratory outpatient clinics for possible asthma diagnosis, underwent standardized exercise testing followed within a week by an MDP challenge (Aridol™, Pharmaxis, Australia). Agreement between the two challenge tests using Cohen's kappa and receiving operating characteristic (ROC) curves was compared.
Results:
One hundred eleven children performed both challenge tests. Twelve children were excluded due to exhaustion or insufficient cooperation (11 at the exercise test, 1 at the MDP challenge), leaving 99 children (mean ± SD age 11.5 ± 2.7 years) for analysis. MDP tests were well accepted, with minor side effects and a shorter duration than exercise tests. The MDP challenge was positive in 29 children (29%), the exercise test in 21 (21%). Both tests were concordant in 83 children (84%), with moderate agreement (κ = 0.58, 95% CI 0.39-0.76). Positive and negative predictive values of the MDP challenge for exercise-induced bronchoconstriction were 68% and 89%. The overall ability of MDP challenge to separate children with or without positive exercise tests was good (area under the ROC curve 0.83).
Conclusions:
MDP challenge test is feasible in children and is a suitable alternative for bronchial challenge testing in childhood.
