Mannitol Bronchial Provocation Tests Research Articles

Serum levels of periostin and exercise-induced bronchoconstriction in asthmatic children

BackgroundPeriostin is induced by IL-13 and has been studied as a biomarker of asthma. The present study explored the relationship between serum levels of periostin and exercise-induced bronchoconstriction (EIB) in asthmatic children. MethodsThe study population consisted of 86 children 6–15 years old divided into an asthmatic group (n = 56) and healthy controls (n = 30). We measured the levels of periostin in serum and performed pulmonary function tests including baseline measurements, post-bronchodilator inhalation tests, exercise bronchial provocation tests (BPTs), and mannitol BPTs. ResultsThe 56 asthmatic children were divided into four groups: asthmatics with positive exercise BPT and positive mannitol BPT (n = 30), asthmatics with positive exercise BPT but negative mannitol BPT (n = 7), asthmatics with negative exercise BPT but positive mannitol BPT (n = 10), and asthmatics with negative exercise BPT and negative mannitol BPT (n = 9). Serum levels of periostin in asthmatic children with both positive exercise and mannitol BPT were significantly greater than those in asthmatic children with both negative exercise and mannitol BPT (95.0 [75.0–104.0] vs. 79.0 [68.0–82.5] ng/mL, P = 0.008) and controls (74.0 [69.75–80.0] ng/mL, P < 0.001). Periostin levels were significantly correlated with both the maximum decrease in %FEV1 and mannitol PD15 value. ConclusionSerum levels of periostin in asthmatic children with both positive exercise and mannitol BPT were significantly greater than those in asthmatic children with both negative exercise and mannitol BPT and also greater than in healthy controls.

A comparison of the utilities of the fractional exhaled nitric oxide level and mannitol bronchial provocation test in terms of predicting exercise-induced bronchoconstriction in asthmatic children

A comparison of the utilities of the fractional exhaled nitric oxide level and mannitol bronchial provocation test in terms of predicting exercise-induced bronchoconstriction in asthmatic children

Comparison of the exercise and mannitol bronchial provocation tests in children with asthma

Comparison of the exercise and mannitol bronchial provocation tests in children with asthma

Serum periostin levels correlate with airway hyper-responsiveness to methacholine and mannitol in children with asthma.

Periostin is a matricellular protein, and its synthesis in airway epithelial cells and lung fibroblasts is induced by interleukin (IL)-4 and IL-13. The significance of periostin as a biomarker of TH 2-induced airway inflammation, and (importantly) as a measure of the response to TH 2-targeted therapy, has recently been emphasized. We explored the relationship between periostin and airway hyperresponsiveness (AHR) in asthmatic children. The study included 83 children aged 6-15 years in an asthmatic group (n = 54) and healthy controls (n = 29). We measured the periostin levels in serum and performed methacholine and mannitol provocation challenges. The responses to mannitol were expressed as the provocative dose causing a 15% fall in the FEV1 (the PD15 dose). Of the 54 subjects with asthma, all had positive methacholine bronchial provocation test (BPT) results and 38 had positive mannitol BPT results. Children with asthma had significantly higher periostin levels than controls [76.0 (65.0-91.8) vs 71.0 (57.5-80.0) ng/mL; P = 0.017]. Periostin levels were significantly correlated with both the methacholine PC20 and mannitol PD15 values. Serum levels of periostin, a new biomarker induced by IL-13, were higher in asthmatic children, and were associated with AHR to methacholine and mannitol.

Pulmonary function assessment in the early phase of patients with smoke inhalation injury from fire.

Fire smoke contains toxic gases and numerous chemical compounds produced by incomplete combustion, and may cause injury to the airways. Increased airway reactivity, as well as a decrease in lung function, has been reported as a sequela of smoke inhalation injury. This study was undertaken to assess lung functions in the early phase of patients with smoke inhalation damage from fires. A total of 15 patients with fire smoke inhalation (fire smoke group) and 15 subjects with chronic cough but no previous history of lung disease (chronic cough group) were enrolled. For diagnosis of inhalation injury, we performed bronchoscopy, high-resolution computed tomography (HRCT), as well as arterial carboxyhemoglobin (COHb) at admission. Clinical characteristics, pulmonary function tests (PFTs) and mannitol bronchial provocation tests (BPTs) were analyzed and compared between the two groups. In fire smoke group, initial COHb levels and the PaO2/FiO2 ratio were (14.8±18.49)% and 425.7±123.68, respectively. Of seven patients performing HRCT, 4 (57.1%) showed the CT findings compatible with lung involvement of inhalation injury. Post bronchodilator value of the percent of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were (76.0±24.27)% and (79.8±27.82)%, respectively. Pre-and post- bronchodilator forced expiratory flow between 25% and 75% of the FVC (FEF25-75) and the percent predicted FEF25-75 were 2.41±1.47 vs. 2.65±1.45 L (P=0.045), and (68.7±37.29)% vs. (76.4±36.70)% (P=0.031), respectively. Two patients (13.3%) had positive bronchodilator response (BDR). In fire smoke and chronic cough group, all the subjects showed mannitol BPTs within normal limits. Fire smoke inhalation leads to mild obstructive small airway disease pattern of pulmonary function in the early phase of patients with fire smoke damage. Further studies, however, need to be followed to identify the relationship between airway narrowing to inhaled mannitol and smoke inhalation injury.

Serum leptin levels correlate with bronchial hyper-responsiveness to mannitol in asthmatic children

Purpose: Epidemiological data indicate that obesity is a risk factor in asthma, however effects related to obesity and adipokines on airway inflammation and bronchial hyper-responsiveness (BHR) have not yet been demonstrated in the human airway. The aim of this study was to investigate the relationship between serum adipokine levels and BHR to mannitol in asthmatic children. Methods: Serum adipokine levels were measured and pulmonary function tests were perfomed: baseline, postbronchodilator inha- lation, methacholine inhalation, and mannitol inhalation. The response to mannitol was expressed as the dose causing a 15% de- crease in forced expiratory volume in one second (FEV1) (PD15), and as the response-dose ratio (RDR) (% fall in FEV1/cumulative dose). Results: Sixty-nine prepubertal children between the ages of 6 and 10 years were participated in the study. They comprised asth- matic children (n = 40) and healthy (n = 29). Twenty-two subjects (55.5%) with asthma had a positive mannitol bronchial provoca- tion test (BPT) result. The body mass index (BMI) was higher in those asthmatics with positive mannitol BPTs than in asthmatics with negative mannitol BPTs and in the control group (19.30 kg/m 2 vs. 17.60 kg/m 2 vs. 17.93 kg/m 2 , P = 0.035, P = 0.046). Serum leptin lev- els were also significantly higher in asthmatics with positive mannitol BPTs than in asthmatics with negative mannitol BPTs and in the control group (10.58 ng/mL vs. 5.49 ng/mL vs. 6.75 ng/mL, P = 0.002, P = 0.016). Leptin values were significantly associated with a PD15 (r = -0.498, P = 0.022) and RDR to mannitol (r = 0.346, P = 0.033) in asthmatic children after adjustment for BMI. Conclusion: Serum leptin levels were significantly associated with BHR to mannitol in asthmatic children. (Allergy Asthma Respir Dis 2014;2:30-37)

Comparison of methacholine and mannitol bronchial provocation tests in workers with occupational asthma

Comparison of methacholine and mannitol bronchial provocation tests in workers with occupational asthma

Inhaled mannitol as a test for bronchial hyper-responsiveness

Bronchial provocation tests (BPTs) are useful for identifying one of the key features of asthma: bronchial hyper-responsiveness (BHR). The symptoms of asthma are not always reflective of the underlying pathophysiology of asthma and there is a need for objective tests to identify the presence and severity of BHR. A new BPT, involving the inhalation of dry powder mannitol, has recently been approved to identify BHR and is now in use as a diagnostic tool for currently active asthma. Airway sensitivity to mannitol identifies BHR that is dependent upon the presence of airway inflammation and would probably benefit from treatment with inhaled corticosteroids. The mannitol BPT is available commercially as a (single-use) test kit (Aridol™/Osmohale™), with the only additional requirement to perform the test being a spirometer. Accordingly, the mannitol BPT provides a point-of-need tool to identify BHR to assist in the diagnosis of asthma.

Airway Response to Mannitol Challenge in Asthmatic Children Using Impulse Oscillometry

Bronchial responsiveness to mannitol has been assessed using multiple forced expiratory maneuvers which are difficult for many children. We determined if responsiveness to mannitol can be assessed in children using effort-independent impulse oscillometry (IOS). Subjects with asthma, 8–21 years old, underwent a mannitol bronchial provocation test. IOS resistance (R5 and R20) values and FEV1 were measured at baseline and after each dose of mannitol. The mannitol challenge was positive with a 15% fall in FEV1 or a ≥ 10% fall in FEV1 between doses of mannitol. There was a significant correlation between the change in FEV1 and the change in IOS R5. Subjects with a positive challenge had a mean decrease in FEV1 of 18.4% ± 5.9% had a mean increase in R5 of 34.8% ± 15%. There was no significant change in R20. Subjects with a negative challenge had no significant change in FEV1, R5, or R20 from baseline. Using effort-independent IOS to assess airflow obstruction with a mannitol challenge is a useful alternative to FEV1 in patients that have difficulty with spirometry tasks. A ≥ 25% increase in R5 indicates a positive challenge.