Methacholine is more sensitive than mannitol for evaluation of bronchial hyperresponsiveness in children with asthma

Andregnette-Roscigno, Victoria; Fernández‐Nieto, Mar; Potro, Manuela García del; Aguado, E.; Sastre, Joaquı́n

doi:10.1016/j.jaci.2010.07.025

Cited by 17 publications

(14 citation statements)

References 8 publications

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“…19 Direct provocation challenge with histamine or methacholine has traditionally been considered to be more sensitive but less specific for asthma diagnosis. 40,41 We hypothesize that mannitol may be more effective as a laryngeal provoking agent due to its direct irritant effects on the upper airway, although we acknowledge its ability to induce laryngoscopically visualized ILO has not been compared to direct challenge agents. Other measurements obtained during bronchial provocation challenge testing, such as the mean decrease in forced inspiratory flow (%FIF 50 ) has not been found to be a reliable method of detecting (exercise induced) ILO.…”

Section: Comorbidities Accompanying Ilo and Asthmamentioning

confidence: 99%

Diagnosis of concomitant inducible laryngeal obstruction and asthma

Lee

Tay

Paddle

et al. 2018

Clin Experimental Allergy

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Section: Comorbidities Accompanying Ilo and Asthmamentioning

confidence: 99%

Diagnosis of concomitant inducible laryngeal obstruction and asthma

Lee

Tay

Paddle

et al. 2018

Clin Experimental Allergy

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“…As the amount of evidence have grown, it does not seem to be as simple as 'direct tests for AHR are sensitive and can rule out asthma' whereas indirect tests are specific and can 'rule in asthma. ' Quite a few comparative studies of inhaled mannitol and methacholine have been conducted, of which a study in an unselected sample of adults [45], a sample of children with asthma [46] as well as a study of subjects with occupational asthma [36] find methacholine to be more sensitive than mannitol in identifying asthma. However, a study conducted in the USA testing 375 subjects with asthma-like symptoms [4] as well as a study on military conscripts [41] found no difference in diagnostic properties between mannitol and methacholine.…”

Section: Diagnostic Propertiesmentioning

confidence: 99%

The use of inhaled mannitol in the diagnosis and management of asthma

Sverrild

Porsbjerg

Backer

2011

Expert Opinion on Pharmacotherapy

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Inhaled mannitol can be regarded as a safe, standardized, specific, but less sensitive, tool for the diagnosis of asthma in both children and adults. Discomfort, in terms of cough, during the test occurs in 85.3% of subjects, but rarely (1.3%) leads to discontinuation. Headache (6.1%), pharyngolaryngeal pain (2.6%) and cough (1.3%) are the most frequent adverse events that occur on the day of the test. The test holds several advantages compared with existing tests; there is no need for additional equipment (i.e., a nebulizer) besides a spirometer; it requires no cleaning and has only one standard operating protocol. In a new study using mannitol for monitoring mild and moderate persistent asthma in primary care, the number of mild exacerbations was reduced.

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“…Mannitol BPT was shown to be comparable to methacholine BPT in terms of discrimination between groups of asthmatic and nonasthmatic children [44]. In contrast, in another study of children presenting with asthma symptoms, mannitol BPT results were poorly correlated with methacholine BPT results [72].…”

Section: Mannitol Bronchoprovocation Test and Response To Therapymentioning

confidence: 88%

Bronchoprovocation tests in asthma

Leüppi

2014

Current Opinion in Pulmonary Medicine

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Airway hyperresponsiveness (AHR) is a characteristic feature of asthma, and its measurement using direct inhalation challenges, particularly with inhaled methacholine or histamine, or indirect challenges using stimuli such as exercise, dry air hyperpnea, distilled water, hypertonic saline and mannitol, and the pharmacological agent adenosine monophosphate is important in establishing a correct diagnosis. Direct challenge tests are sensitive and have a high negative predictive value to exclude asthma. This is particularly true in excluding asthma as a diagnosis in patients with symptoms that suggest asthma, but are caused by another condition. Indirect AHR correlates better with eosinophilic airway inflammation. Therefore, indirect challenge tests are seen as more specific. A newer indirect challenge test that uses a kit containing prepacked capsules of dry powder mannitol in different doses is safe and efficient to use. Indirect challenge tests are superior to direct challenge tests to confirm the presence of asthma.

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Methacholine is more sensitive than mannitol for evaluation of bronchial hyperresponsiveness in children with asthma

Cited by 17 publications

References 8 publications

Diagnosis of concomitant inducible laryngeal obstruction and asthma

Diagnosis of concomitant inducible laryngeal obstruction and asthma

The use of inhaled mannitol in the diagnosis and management of asthma

Bronchoprovocation tests in asthma

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