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Published on: May 4, 2021
Effect of mannitol dry powder challenge on exhaled nitric oxide in children
Juerg Barben1, Marie-Pierre F Strippoli, Daniel Trachsel
1Department of Paediatric Pulmonology & Allergology, Children's Hospital, St. Gallen, Switzerland. juerg.barben@kispisg.ch
Background:
Fractional exhaled nitric oxide (FENO), a non-invasive marker of eosinophilic airway inflammation, is increasingly used for diagnostic and therapeutic decisions in adult and paediatric asthma. Standardized guidelines for the measurement of FENO recommend performing FENO measurements before rather than after bronchial provocation tests.
Objective:
To investigate whether FENO levels decrease after a Mannitol dry powder (MDP) challenge in a clinical setting, and whether the extent of the decrease is influenced by number of MDP manoeuvres, baseline FENO, atopy and doctor diagnosed asthma.
Methods:
Children aged 6-16 years, referred for possible reactive airway disease to a respiratory outpatient clinic, performed an MDP challenge (Aridol®, Pharmaxis, Australia). FENO was measured in doublets immediately before and after the challenge test using the portable NIOX MINO® device (Aerocrine, Stockholm, Sweden). We analysed the data using Kruskal-Wallis rank tests, Wilcoxon signed rank tests and multivariable linear regressions.
Results:
One hundred and seven children completed both tests (mean±SD age 11.5±2.8 years). Overall, median (interquartile range) FENO decreased slightly by -2.5 ppb (-7.0, -0.5), from 18.5 ppb (10.5, 45.5) before the MDP challenge to 16.5 ppb thereafter (8.5, 40.5; p<0.001). In all participants, the change in FENO was smaller than one standard deviation of the baseline mean. The % fall in FENO was smaller in children with less MDP manoeuvres (e.g. higher bronchial responsiveness; p = 0.08) but was not influenced by levels of baseline FENO (p = 0.68), atopy (p = 0.84) or doctor diagnosed asthma (p = 0.93).
Conclusion:
MDP challenge test influences FENO values but differences are small and clinically barely relevant.
Insights
Fractional exhaled nitric oxide (FENO) levels slightly decrease after a Mannitol dry powder (MDP) challenge. These changes in FENO are minimal and not clinically significant for asthma management.
Area of Science:
- Respiratory Medicine
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Fractional exhaled nitric oxide (FENO) is a key non-invasive biomarker for eosinophilic airway inflammation.
- FENO is crucial for diagnosing and managing asthma in both adults and children.
- Current guidelines recommend FENO measurement prior to bronchial provocation tests.
Purpose of the Study:
- To determine if FENO levels decline following a Mannitol dry powder (MDP) challenge.
- To assess if MDP maneuver count, baseline FENO, atopy, or diagnosed asthma affect the FENO decrease.
- To evaluate the clinical relevance of FENO changes post-MDP challenge.
Main Methods:
- A cohort of 107 children (6-16 years) with suspected reactive airway disease underwent an MDP challenge.
- FENO was measured immediately before and after the MDP challenge using the NIOX MINO® device.
- Statistical analysis included Kruskal-Wallis, Wilcoxon signed rank tests, and multivariable linear regressions.
Main Results:
- A slight median decrease in FENO was observed post-MDP challenge (-2.5 ppb; p<0.001).
- The change in FENO was less than one standard deviation of the baseline mean for all participants.
- The reduction in FENO was not significantly influenced by baseline FENO, atopy, or asthma diagnosis, but trended lower with fewer MDP maneuvers.
Conclusions:
- The Mannitol dry powder challenge test does impact FENO measurements.
- However, the observed changes in FENO are small and of limited clinical significance.
- FENO measurements should still be interpreted cautiously in the context of bronchial provocation tests.
