Asthma and lower airway diseaseAirway hyperresponsiveness to mannitol and methacholine and exhaled nitric oxide: A random-sample population study
Section snippets
Study design
The study is a cross-sectional population study performed at the Respiratory Research Unit, Copenhagen University Hospital Bispebjerg, Denmark. The same data were used in the recently published characterization of the diagnostic properties of inhaled mannitol in asthmatic subjects.8 A sample of 1000 young adults between the ages of 14 and 24 years was randomly drawn from the civil registration list. All subjects received a validated self-administered asthma and rhinitis screening questionnaire
Population characteristics
Population characteristics are shown in Table I. Most asthmatic subjects had normal or near-normal lung function in terms of FEV1 and FEV1/forced vital capacity ratio, although the percent predicted FEV1 was slightly lower compared with that seen in nonasthmatic subjects. Most were nonsmokers, and the prevalence of smoking was comparable between asthmatic and nonasthmatic subjects. Atopy was observed in 77% of asthmatic subjects compared with 32% of nonasthmatic subjects.
Current asthma was
Discussion
This study compares the diagnostic properties of inhaled mannitol and methacholine in a random population sample and the correlation with the inflammatory marker eNO. We found that mannitol was significantly more specific in the diagnosis of asthma than methacholine because 98% of the subjects without asthma had a negative mannitol test response compared with 80% when using methacholine, and the respective PPVs were 91% for mannitol compared with 49% for methacholine. As expected based on
References (31)
- et al.
Validation of a life quality (LQ) test for asthma
Ann Allergy Asthma Immunol
(2000) - et al.
The bronchoprotective effect of inhaling methacholine by using total lung capacity inspirations has a marked influence on the interpretation of the test results
J Allergy Clin Immunol
(2006) - et al.
Sensitivity and validity of three bronchial provocation tests to demonstrate the effect of inhaled corticosteroids in asthma
Chest
(2003) - et al.
Guidelines for methacholine and exercise challenge testing-1999
Am J Respir Crit Care Med
(2000) - et al.
Sensitivity and specificity of the histamine challenge test for the diagnosis of asthma in an unselected sample of children and adolescents
Eur Respir J
(1991) - et al.
Combined use of exhaled nitric oxide and airway hyperresponsiveness in characterizing asthma in a large population survey
Eur Respir J
(2000) - et al.
Diagnostic and therapeutic value of airway challenges in asthma
Curr Allergy Asthma Rep
(2009) - et al.
PC(20) adenosine 5′-monophosphate is more closely associated with airway inflammation in asthma than PC(20) methacholine
Am J Respir Crit Care Med
(2001) - et al.
A new method for bronchial-provocation testing in asthmatic subjects using a dry powder of mannitol
Am J Respir Crit Care Med
(1997) - et al.
Relationship between airway responsiveness to mannitol and to methacholine and markers of airway inflammation, peak flow variability and quality of life in asthma patients
Clin Exp Allergy
(2008)
Diagnostic properties of inhaled mannitol in the diagnosis of asthma: a population study
J Allergy Clin Immunol
The bronchial response to mannitol is attenuated by a previous methacholine test: but not vice versa
Clin Exp Allergy
Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999
Am J Respir Crit Care Med
Standardisation of spirometry
Eur Respir J
Rapid method for measurement of bronchial responsiveness
Thorax
Cited by (60)
Airway hyperresponsiveness reflects corticosteroid-sensitive mast cell involvement across asthma phenotypes
2023, Journal of Allergy and Clinical ImmunologyMannitol and the mechanisms behind bronchoconstriction
2019, Journal of Allergy and Clinical ImmunologyBronchoprovocation Testing in Asthma: An Update
2018, Immunology and Allergy Clinics of North AmericaCitation Excerpt :Examples of negative tests include known asthmatic patients being treated effectively with ICSs,142,143 people with eosinophilic bronchitis but no asthma,144 or people with asymptomatic BHR to methacholine who may have airway injury such as elite athletes.121,145,146 Sverrild and colleagues125 evaluated methacholine and mannitol and reported a specificity of 80.2% (95% CI, 77.1%–82.9%) and 98.4% (95% CI, 96.2%–99.4%), respectively, with a positive predictive value of 48.6% versus 90.4%, whereas the sensitivity was 68.6% (95% CI, 57.1%–78.4%) and 58.8% (95% CI, 50.7%–62.6%), respectively. Other trials have reported a sensitivity range between 50% and 60%, with specificities in the high 90% range.
Guidelines for methacholine provocation testing
2018, Revue des Maladies RespiratoiresSimultaneously increased fraction of exhaled nitric oxide levels and blood eosinophil counts relate to increased asthma morbidity
2016, Journal of Allergy and Clinical Immunology
The Danish Agency for Science, Technology and Innovation, an institution under the Danish Ministry of Science, Technology and Innovation, supported the study with a 1-year scholarship. Pharmaxis provided the research team with an unrestricted grant, with which one of the research assistants was employed. Moreover, mannitol test kits were provided by Pharmaxis Ltd (Frenchs Forest, NSW, Australia).
Disclosure of potential conflict of interest: C. Porsbjerg receives honoraria from Pharmaxis and receives research funding for the Danish Agency of Science and Technology. The rest of the authors have declared that they have no conflict of interest.