The bronchial response to mannitol is attenuated by a previous methacholine test: but not vice versa

Authors: Gade, E.; Thomsen, S. F.; Porsbjerg, C.; Backer, V.

Source: Clinical & Experimental Allergy, Volume 39, Number 7, July 2009 , pp. 966-971(6)

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Abstract:

Summary Aim

To examine the airway response to inhaled mannitol performed before or after a methacholine challenge test in a group of asthmatics with different levels of disease. Methods

A total of 48 asthmatics, 18-73 years of age, were included in the study. Two pairs of challenges were performed in a random order on two separate days ⩾24 h apart: either with mannitol performed first on day one, followed ⩾1 h by methacholine, and methacholine as the first on day two, followed ⩾1 h by mannitol or vice versa. A questionnaire-based interview was performed and lung function, exhaled nitric oxide, skin prick test, and blood eosinophil count were measured. Results

A total of 44% of the asthmatics used inhaled corticosteroids and 48% were atopic. The airway response to mannitol was attenuated when mannitol was given after methacholine, compared with the response to mannitol when it was given first [log response dose ratio (RDR): 1.42 vs. 1.60 (P=0.004)], whereas the response to methacholine was unchanged in the opposite test order [log RDR: 0.81 vs. 0.96 (P=0.102)]. Conclusion

Bronchial challenges with inhaled mannitol and methacholine may be performed on the same day but provocation with mannitol should be performed before methacholine.

Keywords: asthma; bronchial provocation tests; mannitol; methacholine; serial challenging

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1365-2222.2009.03274.x

Affiliations: 1: Department of Respiratory Medicine, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark

Publication date: 2009-07-01