Responsiveness to Mannitol in Asthmatic Subjects with Exercise- and Hyperventilation-induced Asthma

• Published in: American journal of respiratory and critical care medicine Vol. 158; no. 4; pp. 1120 - 1126
• Main Authors: BRANNAN, JOHN D., KOSKELA, HEIKKI, ANDERSON, SANDRA D., CHEW, NORA
• Format: Journal Article
• Language: English
• Published: New York, NY American Lung Association 01.10.1998
• Subjects: Adolescent; Adult; Anti-Asthmatic Agents - therapeutic use; Asthma - diagnosis; Asthma - drug therapy; Asthma - etiology; Asthma, Exercise-Induced - diagnosis; Asthma, Exercise-Induced - drug therapy; Biological and medical sciences; Bronchial Hyperreactivity - diagnosis; Bronchial Hyperreactivity - drug therapy; Bronchial Provocation Tests - methods; Bronchoconstriction - drug effects; Bronchodilator Agents - therapeutic use; Capsules; Chronic obstructive pulmonary disease, asthma; Diuretics, Osmotic - administration & dosage; Dose-Response Relationship, Drug; Female; Forced Expiratory Volume - drug effects; Glucocorticoids - therapeutic use; Humans; Hyperventilation - complications; Male; Mannitol - administration & dosage; Medical sciences; Nebulizers and Vaporizers; Pneumology; Powders; Sensitivity and Specificity; Time Factors; Physical exercise; Human; Respiratory disease; Mannitol; Exploration; Obstructive pulmonary disease; Maximal expiratory volume per second; Hyperventilation; Asthma; Provocation test
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.158.4.9802087

We investigated airway responsiveness to mannitol, a new hyperosmolar challenge, in persons hyperresponsive to airway drying. We studied 36 asthmatic subjects, 18 to 40 yr of age, responsive to exercise (n = 23) and eucapnic hyperventilation (n = 28) defined by a 10% fall in FEV1. Fifteen subjects performed both challenges. All subjects performed a challenge with dry powder mannitol, encapsulated and delivered via a Dinkihaler until a 15% decrease in FEV1 was documented or a cumulative dose of 635 mg was delivered. All subjects responsive to eucapnic hyperventilation and all but one subject responsive to exercise were responsive to mannitol. Sixty-nine percent of subjects had a positive response to mannitol after less than 155 mg (6 capsules) and 94% less than 320 mg (10 capsules). The provoking dose of mannitol required to cause a 15% fall in FEV1 (PD15) was related to the severity of the response to exercise (Pearson's correlation coefficient [rp] = 0.68, p < 0.01) and eucapnic hyperventilation (rp = 0.68, p < 0.01) in subjects who were not taking inhaled corticosteroids. The mean (+/- SD) maximum percent fall in FEV1 after mannitol was 24.4 +/- 6.2% and recovery to bronchodilator occurred within 10 min in most subjects. The mannitol test is simple, inexpensive, faster to perform than hyperpnea with dry air and could become an office-based test. Further studies are now required to determine the sensitivity of mannitol to identify exercise-induced asthma in a random population.