ATS Pulmonary Function Laboratory Manual

ATS Pulmonary Function Laboratory Management & Procedure Manual | 3rd Edition

Effective Date: 2014 Version #1

Chapter 13

Procedure Name: Mannitol Challenge Test

Purpose or Principle Airway hyperresponsiveness can be assessed by bronchial provocation tests (bronchial challenges) using direct or indi- rect stimuli. Challenges with direct stimuli (e.g., methacholine) act directly on the airway smooth muscle causing airway narrowing. Challenges with indirect stimuli, such as mannitol, adenosine, specific allergens, and exercise, act by causing a release of mediators from inflammatory cells (e.g., prostaglandins, leukotrienes, and histamine) and neuropeptides from sensory nerves, which in patients with asthma causes exaggerated airway narrowing and airflow limitation. The use of mannitol as a bronchial challenge agent was first described by Anderson and colleagues in the late 1990s (1). Mannitol challenges have been found to be safe and useful in identifying patients with asthma responsive to hypertonic saline, eucapnic hyperventilation, and exercise (2). Mannitol is considered to be more specific, but less sensitive than methacholine for asthma. Mannitol is a naturally occurring sugar hexahydric alcohol found in most vegetables. The formulation prepared for bronchial challenges is a white crystalline powder contained within gelatin capsules. It is sold as Aridol by Pharmaxis Ltd, Australia, and supplied in a kit containing the necessary capsules to complete one challenge along with the inhaler. The capsules are color coded in doses of 5, 10, 20, and 40 mg. Also included is a 0-mg clear capsule administered as a control.

Indications and Contraindications The indications for the mannitol challenge testing are provided in Table 13.1, with the relative contraindications in Table 13.2. The list of possible contraindications may not be all-inclusive and therefore is not a substitute for clinical judgment.

Table 13.1

Indications for Mannitol Challenge Test

Indications for testing include: • Assess pre-test probability of asthma in those with asthma-like symptoms (3) • Monitor asthma treatment response • Determine level of airway inflammation • Determine effectiveness of inhaled corticosteroid therapy (4) • Predict whether or not inhaled corticosteroid dose can be reduced (5, 6)

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