An open-label study examining the effect of pharmacological treatment on mannitol- and exercise-induced airway hyperresponsiveness in asthmatic children and adolescents with exercise-induced bronchoconstriction.

Salome Schafroth Török,Anja Jochmann,Ladina Joos Zellweger,Thomas Mueller,Alexandra Goll,Sabine Sauter,Jörg D Leuppi,Anne B Taegtmeyer,Prashant N Chhajed,David Miedinger,Bruno Knöpfli

doi:10.1186/1471-2431-14-196

Salome Schafroth Török, Anja Jochmann + Show 9 more

Open Access

https://doi.org/10.1186/1471-2431-14-196

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Abstract

BackgroundMannitol- and exercise bronchial provocation tests are both used to diagnose exercise-induced bronchoconstriction. The study aim was to compare the short-term treatment response to budesonide and montelukast on airway hyperresponsiveness to mannitol challenge test and to exercise challenge test in children and adolescents with exercise-induced bronchoconstriction.MethodsPatients were recruited from a paediatric asthma rehabilitation clinic located in the Swiss Alps. Individuals with exercise-induced bronchoconstriction and a positive result in the exercise challenge test underwent mannitol challenge test on day 0. All subjects then received a treatment with 400 μg budesonide and bronchodilators as needed for 7 days, after which exercise- and mannitol-challenge tests were repeated (day 7). Montelukast was then added to the previous treatment and both tests were repeated again after 7 days (day 14).ResultsOf 26 children and adolescents with exercise-induced bronchoconstriction, 14 had a positive exercise challenge test at baseline and were included in the intervention study. Seven of 14 (50%) also had a positive mannitol challenge test. There was a strong correlation between airway responsiveness to exercise and to mannitol at baseline (r = 0.560, p = 0.037). Treatment with budesonide and montelukast decreased airway hyperresponsiveness to exercise challenge test and to a lesser degree to mannitol challenge test. The fall in forced expiratory volume in one second during exercise challenge test was 21.7% on day 0 compared to 6.7% on day 14 (p = 0.001) and the mannitol challenge test dose response ratio was 0.036%/mg on day 0 compared to 0.013%/mg on day 14 (p = 0.067).ConclusionShort-term treatment with an inhaled corticosteroid and an additional leukotriene receptor antagonist in children and adolescents with exercise-induced bronchoconstriction decreases airway hyperresponsiveness to exercise and to mannitol.

Highlights

Mannitol- and exercise bronchial provocation tests are both used to diagnose exercise-induced bronchoconstriction
Lung function at baseline was normal in all patients with a mean One second forced expiratory volume (FEV1) of 111% predicted (±16%) and a mean forced vital capacity (FVC)% of 115% predicted (±17%)
Fourteen patients had a positive exercise challenge test (ECT) and proceeded to optimized treatment, their baseline characteristics and lung function are shown in detail in Table 1 where the results are stratified according to the mannitol challenge test (MCT) outcome

Summary

Introduction

Mannitol- and exercise bronchial provocation tests are both used to diagnose exercise-induced bronchoconstriction. The study aim was to compare the short-term treatment response to budesonide and montelukast on airway hyperresponsiveness to mannitol challenge test and to exercise challenge test in children and adolescents with exercise-induced bronchoconstriction. The indirect tests can be subdivided into physical stimuli such as exercise, eucapnic voluntary hyperventilation, cold air hyperventilation, hypertonic saline and mannitol, and the pharmacological agent adenosine monophosphate. These indirect BPTs cause airflow limitation through inducing a release of mediators from inflammatory cells and sensory nerves. The mediators act on smooth muscle cell causing contraction which results in airway narrowing [2,3,4]

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