ATS Pulmonary Function Laboratory Manual

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

Test Procedure for Mannitol Challenge Test (7)

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Step Action 7.5.

Instruct the patient to inhale the contents of the second capsule immediately to endure that the osmotic effect of mannitol is cumulative. 7.6. Set the timer for 60 seconds when the contents of second 40-mg capsule has been inhaled. 7.7. Instruct the patient to hold their breath for 5 seconds before exhaling. 7.8. At 60 seconds following inhalation of the contents of the second capsule, perform spirometry on patient and obtain two FEV 1 values. Acceptability criteria must be met. Use the higher of these two values to calculate the change in FEV 1 . 7.9. Compare the FEV 1 value at this dose to the target FEV 1 . If the FEV 1 is equal to or below the target value, or there has been an incremental fall of at least 10% from the previous dose, the challenge is positive and complete. If not, immediately proceed to the next dose. 8. Administer first 160-mg dose (4 × 40-mg capsules) 8.1. Insert and pierce the first of the four 40-mg capsules that comprise the 160-mg dose. 8.2. The patient should inhale the dose in the same manner as previous doses, hold their breath for the five seconds then exhale. 8.3. Remove the capsule from the inhaler and check to ensure it has been emptied sufficiently; if not, a second inhalation will be required immediately. Do this check following the inhalation of the contents of each capsule. 8.4. Following inhalation, load the second 40-mg capsule and administer it immediately following the exhalation after the first 40-mg capsule. 8.5. The patient should hold their breath for 5 seconds, then exhale. 8.6. Following inhalation, load the third 40-mg capsule and administer it immediately following exhalation. 8.7. The patient should inhale the contents of the third capsule, hold their breath for 5 seconds, then exhale. 8.8. Immediately following inhalation, load the fourth 40-mg capsule and give to the patient immediately following exhalation. 8.9. Instruct the patient to inhale the fourth capsule immediately to ensure the osmotic effect of mannitol is cumulative. 8.10. Set the timer for 60 seconds when the contents of fourth 40-mg capsule has been inhaled. 8.11. Instruct the patient to hold their breath for 5 seconds before exhaling. 8.12. At 60 seconds following inhalation of the contents of the fourth capsule, perform spirometry on patient and obtain two FEV 1 values. Acceptability criteria must be met. Use the higher of these two values to calculate the change in FEV 1 . 8.13. Compare the FEV 1 value at this dose to the target FEV 1 . If the FEV 1 is equal to or below the target value, or there has been an incremental fall of at least 10% from the previous dose, the challenge is positive and complete. If not, immediately proceed to the next dose. 9. Administer second 160-mg dose (4 × 40-mg capsules) 9.1. Administer the second 160-mg dose following the directions in Step 8.

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