title: Diagnostic properties of the methacholine and mannitol bronchial challenge tests: a comparison study.
abstract: OBJECTIVE
  Airway hyperresponsiveness is a common feature of asthma. Methacholine and mannitol are two representative agonists for bronchial challenge. They have theoretically different mechanisms of action, and may have different diagnostic properties. However, their difference has not been directly evaluated among Korean adults. In this study, we compare the diagnostic properties of methacholine and mannitol bronchial provocation tests.
  
  
  METHODS
  Asthmatic patients and non-asthmatic controls were recruited prospectively from four referral hospitals in Korea. Participants were challenged with each of methacholine and mannitol inhalation on different days. Their diagnostic utility was evaluated by calculating their sensitivity and specificity for asthma diagnosis. Response-dose ratio was also compared.
  
  
  RESULTS
  A total of 50 asthmatic adults and 54 controls were enrolled (mean age 43.8 years). The sensitivity and specificity of mannitol challenge (defined by a PD15 of <635 mg) were 48.0% and 92.6%, respectively, whereas those of methacholine (defined by a PC20 of <16 mg/mL) were 42.0% and 98.1%, respectively. Twenty asthmatic participants (24%) showed positive response to a single agonist only. In the receiver operating curve analyses using response-dose ratio values, area under the curve was 0.77 (95% confidence interval (CI): 0.68-0.86) for mannitol, and 0.89 (95% CI: 0.83-0.95) for methacholine. The correlations between log- transformed mannitol and methacholine response-dose ratios were significant but moderate (r = 0.683, P < 0.001).
  
  
  CONCLUSIONS
  The present study demonstrated overall similar diagnostic properties of two diagnostic tests, but also suggested their intercomplementary roles for asthma. The clinical trial registration number at ClinicalTrial.gov is NCT02104284.
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors: Min-Hye
authors: MH
authors: Kim
authors: Woo-Jung
authors: WJ
authors: Song
authors: Tae-Wan
authors: TW
authors: Kim
authors: Hyun-Jung
authors: HJ
authors: Jin
authors: You-Seob
authors: YS
authors: Sin
authors: Young-Min
authors: YM
authors: Ye
authors: Sang-Heon
authors: SH
authors: Kim
authors: Heung-Woo
authors: HW
authors: Park
authors: Byung-Jae
authors: BJ
authors: Lee
authors: Hae-Sim
authors: HS
authors: Park
authors: Ho-Joo
authors: HJ
authors: Yoon
authors: Dong-Chull
authors: DC
authors: Choi
authors: Kyung-Up
authors: KU
authors: Min
authors: Sang-Heon
authors: SH
authors: Cho
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D001985:Bronchial Provocation Tests / Q000379:methods*; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects; D008297:Male; D008353:Mannitol / Q000494:pharmacology; D016210:Methacholine Chloride / Q000494:pharmacology; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D056910:Republic of Korea / Q000453:epidemiology; D012680:Sensitivity and Specificity
chemical_list: D016210:Methacholine Chloride; D008353:Mannitol
keywords: bronchial provocation test; mannitol; methacholine; sensitivity; specificity.