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

Sverrild, Asger; Porsbjerg, Celeste; Backer, Vibeke

doi:10.1517/14656566.2012.638917

Cited by 22 publications

(28 citation statements)

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“…The present survey does not support the recommendation of starting with reversibility testing before any challenge testing, whereas the use of direct and indirect challenge tests was found to have a better distribution of sensitivity and specificity; methacholine had the highest sensitivity for detection of asthma ( Table 4 ), but mannitol had the best association between sensitivity and specificity ( Table 4 ). These findings are somewhat different from earlier findings in selected groups of asthma patients ( 25 ) and random population studies ( 26 , 27 ). In an unselected group of young adults, the sensitivity of methacholine and mannitol was found to be 80% for both ( 27 ), which is substantially higher than in the present study where the sensitivity to methacholine was 65% and to mannitol 38%.…”

Section: Discussioncontrasting

confidence: 99%

Diagnostic work-up in patients with possible asthma referred to a university hospital

Backer

Sverrild

Ulrik

et al. 2015

European Clinical Respiratory Journal

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ObjectiveThe best strategy for diagnosing asthma remains unclear. Accordingly, the aim of this study was to evaluate diagnostic strategies in individuals with possible asthma referred to a respiratory outpatient clinic at a university hospital.MethodsAll individuals with symptoms suggestive of asthma referred over 12 months underwent spirometry, bronchodilator reversibility test, Peak expiratory flow rate (PEF) registration, and bronchial challenge test with methacholine and mannitol on three separate days. The results of these tests were compared against an asthma diagnosis based on symptoms, presence of atopy and baseline spirometry made by a panel of three independent respiratory specialists.ResultsOf the 190 individuals examined, 63% (n=122) were classified as having asthma. Reversibility to β2-agonist had the lowest sensitivity of 13%, whereas airway hyperresponsiveness to methacholine had the highest (69%). In contrast, specificity was the highest for reversibility testing (93%), whereas methacholine had the lowest specificity (57%). The combination of reversibility, peak-flow variability, and methacholine yielded a cumulative sensitivity of 78%, albeit a specificity of 41%. In comparison, a combination of reversibility and mannitol resulted in a specificity of 82% and a sensitivity of 42%.ConclusionIn this real-life population, different diagnostic test combinations were required to achieve a high specificity for diagnosing asthma and a high sensitivity, respectively: Our findings suggest that the diagnostic test approach should be based on whether the aim is to exclude asthma (high sensitivity required) or confirm a diagnosis of asthma (high specificity required).

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Section: Discussioncontrasting

confidence: 99%

Diagnostic work-up in patients with possible asthma referred to a university hospital

Backer

Sverrild

Ulrik

et al. 2015

European Clinical Respiratory Journal

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“…Test prowokacyjny z mannitolem W ostatnim czasie obserwuje się większe zainteresowanie testem prowokacyjnym z użyciem mannitolu, który ze względu na dużą swoistość, prostą metodykę i stosunkowo krótki czas wykonania badania znajduje zastosowanie w diagnostyce astmy oskrzelowej, również tej o podłożu zawodowym [31]. W wielu krajach są dostępne komercyjne zestawy z mannitolem do oceny BHR, niestety test ten nie jest jeszcze rutynowo wykorzystywany w Polsce [13,32,33].…”

Section: Testy Prowokacyjne Bezpośrednie Test Prowokacji Bezpośrednieunclassified

“…Mechanizm działania mannitolu stosowanego w testach oceny BHR polega na wywołaniu zmian osmotycznych, w których wyniku dochodzi do aktywacji komórek tucznych i uwalniania z nich licznych mediatorów zapalenia, m.in. histaminy, prostaglandyn, cytokin oraz leukotrienów [31]. Test prowokacyjny dooskrzelowy z mannitolem jest testem jakościowym oceniającym BHR, chociaż Anderson i wsp.…”

Section: Testy Prowokacyjne Bezpośrednie Test Prowokacji Bezpośrednieunclassified

“…W ostatnich latach coraz częściej są podejmowane próby wykorzystania testu z mannitolem w diagnostyce zawodowej astmy oskrzelowej w celu oceny BHR podczas monitorowania próby SICT. Związane jest to przede wszystkim z dużą swoistością (ok. 95%) tego testu oraz występowaniem korelacji między BHR a liczbą eozynofilów w plwocinie indukowanej i stężeniem FeNO w powietrzu wydychanym [31]. Davis i wsp., monitorując SICT testem z metacholiną, wykazali znaczny wzrost BHR w 24. godzinie po SICT oraz korelację między BHR a stężeniem FeNO w powietrzu wydychanym.…”

Section: Diagnostyka Astmy Zawodowejunclassified

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The usefulness of bronchial challenge tests in the diagnosis of occupational asthma

Nowakowska‐Świrta

Wiszniewska

Walusiak‐Skorupa

2018

Med Pr

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Bronchial hyperresponsiveness (BHR) is the individual ability to respond with bronchoconstriction to a variety of specific and nonspecific stimuli which do not cause these symptoms among healthy subjects. Bronchial hyperresponsiveness is one of the hallmark features of asthma. The degree of bronchial hyperresponsiveness is variable among individuals with asthma and may correlate to its severity (the more severe asthma the higher bronchial hyperreactivity). Bronchial hyperresponsiveness is evaluated by performing bronchial provocation test (BPT). Provocation tests are classified - according to their mechanisms - into direct and indirect tests. Direct challenge tests are highly sensitive and they are used primarily to rule out asthma. In contrast, provocation tests with indirect stimuli are less sensitive but more specific to the direct tests; they are used generally to confirm the diagnosis of asthma and they allow for more accurate conclusions about inflammatory lesions in the case of a patient. Bronchial provocation tests play a significant role in occupational medicine. They are particularly relevant to be performed prior to employment, during periodic examinations, and to diagnose and monitor both occupational asthma and work-related asthma. This article presents selected bronchial provocation tests and their usefulness in the diagnosis of occupational asthma. Med Pr 2018;69(4):457-471.

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“…Oral mannitol inhalation powder (Aridol Ò /Osmohale Ò ) is a well-characterized indirect bronchial challenge test suitable for use in a primary-care setting [4]. It is also standardized, reproducible and correlate to the degree of inflammation in the airways.…”

Section: Mannitol Challenge and Reversibility Testsmentioning

confidence: 99%

Asthma control in patients on fixed dose combination evaluated with mannitol challenge test

Romberg¹,

Berggren

Bjermer

2014

Respiratory Medicine

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Asthma is often difficult to control and it is likely that not all patients are optimally treated. This study aimed to explore asthma control in adults receiving fixed dose combination (FDC) therapy. Control of asthma was assessed using the mannitol challenge test as a monitoring tool to see if this would give additional information compared to the asthma control test (ACT). The study was an open-label, prospective study on 98 adults prescribed with FDC therapies for at least three months. 74 patients considered that their asthma was well controlled. However, 60 patients had a positive mannitol challenge test (PD15 < 635 mg), and when those with a positive response to the short-acting β2-agonist (≥15%) after the mannitol challenge test were included, this increased to 64 patients (65%). Exploratory analysis determined that the spirometry parameters; FEV1/FVC and FEV1% of predicted, were statistically significant predictors of a positive mannitol challenge test. Co-morbid conditions such as concomitant upper airway involvement or eczema did not predict mannitol reactivity. Although most patients rated their asthma as well controlled, many provided a positive mannitol challenge test, suggesting the presence of underlying inflammation, despite treatment with fixed dose combination therapy.

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

Cited by 22 publications

References 52 publications

Diagnostic work-up in patients with possible asthma referred to a university hospital

Diagnostic work-up in patients with possible asthma referred to a university hospital

The usefulness of bronchial challenge tests in the diagnosis of occupational asthma

Asthma control in patients on fixed dose combination evaluated with mannitol challenge test

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