Published ahead of print on November 27, 2002, doi:10.1164/rccm.200208-916OC Am. J. Respir. Crit. Care Med., Volume 167, Number 4, February 2003, 534-537 A more recent version of this article appeared on February 15, 2003
Submitted on August 23, 2002 MANNITOL AS A CHALLENGE TEST TO IDENTIFY EXERCISE-INDUCED BRONCHOCONSTRICTION IN ELITE ATHLETESKaren Holzer1,1 Allergy, Asthma and Clinical Immunology, Alfred Hospital and Monash University, Melbourne, Victoria, Australia, 2 Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia, 3 Pharmacy, University of Sydney, Sydney, NSW, Australia * To whom correspondence should be addressed. E-mail: sandya{at}mail.med.usyd.edu.au.
Bronchial provocation tests provide objective criteria for asthma and EIB and were recommended to justify the use of inhaled beta2 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, unselected for respiratory symptoms. Twenty-seven subjects had a previous doctor diagnosis of asthma, and 21 were currently taking treatment for EIB or asthma. The mean predicted FEV1 was 103.6 ± 10.8 %, FVC 99 ± 13.3%, and FEF25-75 104 ± 22.7%. Twenty-five of the subjects were positive to EVH challenge (Mean % fall FEV1 25.4 ± 15% SD), and 26 had a positive mannitol challenge (geometric mean (95% CI) 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: osmotic aerosol, eucapnic voluntary hyperpnea
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