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Clinical Investigations: ASTHMA |

Responsiveness to Three Bronchial Provocation Tests in Patients With Asthma*

Heikki O. Koskela; Liisa Hyvärinen; John D. Brannan; Hak-Kim Chan; Sandra D. Anderson
Author and Funding Information

*From the Department of Respiratory Medicine (Drs. Koskela and Hyvärinen), Kuopio University Hospital, Kuopio, Finland; Department of Respiratory Medicine (Drs. Brannan and Anderson), Royal Prince Alfred Hospital, Camperdown, NSW, Australia; and Department of Pharmacy (Dr. Chan), University of Sydney, NSW, Australia.

Correspondence to: Heikki Koskela, MD, Department of Respiratory Medicine, Kuopio University Hospital, PL 1777, 70210 Kuopio, Finland; e-mail: heikki.koskela@kuh.fi



Chest. 2003;124(6):2171-2177. doi:10.1378/chest.124.6.2171
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Study objectives: To compare a new bronchial provocation test, the mannitol challenge, with cold air and histamine challenges to demonstrate airway hyperresponsiveness (AHR) in patients with difficult-to-diagnose asthma.

Design: A prospective study.

Participants: Thirty-seven consecutive patients with recently diagnosed, steroid-naive, mild, or atypical asthma fulfilling the diagnostic criteria of Finnish Social Insurance Institution, and 10 healthy control subjects.

Interventions: Each subject completed a symptom questionnaire and underwent spirometry, diffusion capacity measurement, skin-prick tests, and bronchial provocations with mannitol, histamine, and cold air. The severity of asthma was classified according to the Global Initiative for Asthma (GINA).

Results: Fifty-one percent of the asthmatic patients responded to mannitol (≥ 15% fall in FEV1), 24% to cold air (≥ 9% fall in FEV1), and 81% or 49% to histamine (provocative dose causing a 15% fall in FEV1 [PD15] < 1.0 mg or < 0.4 mg, respectively). None of the healthy control subjects responded. The GINA classification was not associated with responsiveness to any of the challenges.

Conclusions: Mannitol is more sensitive than cold air in demonstrating AHR in patients with mild or atypical asthma. Histamine was more sensitive than both mannitol and cold air if 1.0 mg was used as a cut-off value for histamine PD15. However, if the cut-off value for histamine PD15 is lowered to 0.4 mg, which represents a specific diagnosis of asthma according to previous studies, the sensitivity values of mannitol and histamine challenges are comparable.

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