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Mannitol as a Challenge Test to Identify Exercise-induced Bronchoconstriction in Elite Athletes

Department of Allergy, Asthma, and Clinical Immunology, Alfred Hospital and Monash University, Prahran, Victoria; Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown; and Department of Pharmacy, University of Sydney, Sydney, New South Wales, Australia

Correspondence and requests for reprints should be addressed to Dr. Sandra Anderson, Ph.D., D.Sc., Department of Respiratory Medicine, E11S, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia. E-mail: sandya{at}mail.med.usyd.edu.au

Bronchial provocation tests provide objective criteria for asthma and exercise-induced bronchoconstriction (EIB) and were recommended to justify the use of inhaled ß₂-agonists by athletes at the Winter Olympics 2002. Eucapnic voluntary hyperpnea (EVH) was one test recommended to identify EIB. Provocation with EVH requires a special dry gas mixture limiting its availability. Provocation tests with osmotic aerosols require less expensive equipment that is easily portable. We assessed the sensitivity of a challenge with mannitol to identify responsiveness to EVH in 50 elite summer sport athletes who were unselected if they had respiratory symptoms. Asthma was previously diagnosed by a doctor in 27 subjects, and 21 subjects were currently under treatment for EIB or asthma. The mean predicted FEV₁ was 103.6 ± 10.8%, FVC was 99 ± 13.3%, and mean forced expiratory flow during the middle half of the FVC was 104 ± 22.7%. A total of 25 subjects were positive to EVH challenge (mean percentage of fall in FEV₁ was 25.4 ± 15% SD), and 26 subjects had a positive mannitol challenge (geometric mean [95% confidence interval] provoking dose causing a 10% fall in forced expiratory volume in one second [PD₁₀] was 202 mg [134, 300], with 24 of the subjects positive to both challenges). Mannitol had a sensitivity of 96% and specificity of 92% to identify a positive response to EVH and, as such, could be used as an alternative to EVH to identify EIB.

Key Words: athletes • exercise • asthma • osmotic aerosol • hyperpnea

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