title: Prediction of treatment-response to inhaled corticosteroids by mannitol-challenge test in COPD. A proof of concept.
abstract: BACKGROUND
  There are no predictors known that can identify COPD patients who will respond to treatment with ICS.
  
  
  METHODS
  We investigated 30 patients (median age 65 (range 44-83, 12 females) with mild to moderately severe COPD. All patients had post bronchodilator FEV1/forced vital capacity ratio of less than 70% and a reversibility of less than 12% and 200 ml from baseline. We wanted to determine if airway responsiveness (AHR) to histamine and mannitol could predict who would respond to a 3-month course of ICS.
  
  
  RESULTS
  At baseline, all patients had AHR to histamine, but only 7 (23%) patients to mannitol. After 3 months of treatment with ICS, there was no significant change in spirometry or the quality of life when analysing all individuals together. However, FEV1% predicted improved from 67% (IQR12) to 79% (IQR16) in mannitol positive patients; whereas it was unchanged in the mannitol negative patients. The difference in the mean change of FEV1% predicted between the two groups was 12 (IQR13.5) and this was highly significant (p=0.001). The improvement in quality of life (SGRQ 30 (IQR10.5) to 21 (IQR12; p=0.01) was only significant in the patients positive to mannitol.
  
  
  CONCLUSIONS
  We propose that AHR to mannitol could predict ICS-responsiveness in mild to moderately severe COPD patients.
authors.affiliation: Pneumology, Department of Internal Medicine, University Hospital, Petersgraben 4, Basel CH-4031, Switzerland. jleuppi@uhbs.ch
authors.forename: Jörg D
authors.initials: JD
authors.lastname: Leuppi
authors.forename: Ryan
authors.initials: R
authors.lastname: Tandjung
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Anderson
authors.forename: Daiana
authors.initials: D
authors.lastname: Stolz
authors.forename: Martin H
authors.initials: MH
authors.lastname: Brutsche
authors.forename: Roland
authors.initials: R
authors.lastname: Bingisser
authors.forename: André P
authors.initials: AP
authors.lastname: Perruchoud
authors.forename: Christian
authors.initials: C
authors.lastname: Surber
authors.forename: Andreas
authors.initials: A
authors.lastname: Knoblauch
authors.forename: Morgan
authors.initials: M
authors.lastname: Andersson
authors.forename: Lennart
authors.initials: L
authors.lastname: Greiff
authors.forename: Hak-Kim
authors.initials: HK
authors.lastname: Chan
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001985:Bronchial Provocation Tests; D016085:Bronchoconstrictor Agents; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006632:Histamine; D006801:Humans; D008297:Male; D008353:Mannitol; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D011788:Quality of Life; D013147:Spirometry; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology
chemical_list: D016085:Bronchoconstrictor Agents; D001993:Bronchodilator Agents; D008353:Mannitol; D019819:Budesonide; D006632:Histamine