title: Mannitol as a challenge test to identify exercise-induced bronchoconstriction in elite athletes.
abstract: Bronchial provocation tests provide objective criteria for asthma and exercise-induced bronchoconstriction (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 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.
authors.affiliation: Department of Allergy, Alfred Hospital and Monash University, Prahran, Victoria, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Holzer
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Anderson
authors.forename: Hak-Kim
authors.initials: HK
authors.lastname: Chan
authors.forename: Jo
authors.initials: J
authors.lastname: Douglass
mesh_terms: D000293:Adolescent; D000328:Adult; D001250:Asthma, Exercise-Induced / Q000175:diagnosis*; D001985:Bronchial Provocation Tests / Q000379:methods*; D004234:Diuretics, Osmotic; D005260:Female; D006801:Humans; D008297:Male; D008353:Mannitol; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D013177:Sports; D018709:Statistics, Nonparametric
chemical_list: D004234:Diuretics, Osmotic; D008353:Mannitol