title: Mannitol challenge testing for asthma in a community cohort of young adults.
abstract: Mannitol challenge testing is an established tool for clinical asthma diagnosis, and can be performed outside of specialized respiratory laboratories. Despite applicability in both clinical and non-clinical populations, with different pre-test asthma probabilities, differences in diagnostic properties have not been well explored. This study aimed to quantify the diagnostic utility of mannitol challenge testing for asthma in a community cohort and a symptomatic wheezing subset of this cohort.
  
  
  
  During the 22-year follow-up of the Western Australian Pregnancy (Raine) Cohort, 772 participants (384 males) completed mannitol challenge and skin prick testing and respiratory health questionnaires, of whom 148 reporting wheeze in the past 12 months were included in a wheezing subset.
  
  
  
  Responsiveness to mannitol had low sensitivity (19%) and high specificity (97%) to identify current asthma in the complete cohort, with positive and negative predictive values (PPV and NPV) of 45% and 92%, respectively. Within the wheezing subset, sensitivity (19%) and specificity (94%) remained similar, but PPV increased to 79%, and NPV decreased to 52%.
  
  
  
  Our findings support previously reported high specificity and good PPV for mannitol challenge testing in symptomatic wheezing populations, and highlight the need for caution when interpreting mannitol test results in non-clinical populations.
authors.affiliation: Telethon Kids Institute, Perth, Perth, Western Australia, Australia.|Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Elisha C
authors.initials: EC
authors.lastname: White
authors.affiliation: Telethon Kids Institute, Perth, Perth, Western Australia, Australia.|Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: de Klerk
authors.affiliation: Telethon Kids Institute, Perth, Perth, Western Australia, Australia.|Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.|Children's Lung Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Hantos
authors.affiliation: Telethon Kids Institute, Perth, Perth, Western Australia, Australia.
authors.forename: Monique
authors.initials: M
authors.lastname: Priston
authors.affiliation: Telethon Kids Institute, Perth, Perth, Western Australia, Australia.|Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Elysia M
authors.initials: EM
authors.lastname: Hollams
authors.affiliation: Department of Pulmonary Physiology/West Australian Sleep Disorders Research Institute, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia.|School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: James
authors.affiliation: Children's Lung Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Sly
authors.affiliation: Telethon Kids Institute, Perth, Perth, Western Australia, Australia.|Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.|Children's Lung Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Holt
authors.affiliation: Telethon Kids Institute, Perth, Perth, Western Australia, Australia.|Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.|School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
authors.forename: Graham L
authors.initials: GL
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology; D001985:Bronchial Provocation Tests / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005540:Forced Expiratory Flow Rates / Q000187:drug effects; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008297:Male; D008353:Mannitol / Q000008:administration & dosage*; D012882:Skin Tests / Q000379:methods*; D011795:Surveys and Questionnaires; D013549:Sweetening Agents / Q000008:administration & dosage; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
chemical_list: D013549:Sweetening Agents; D008353:Mannitol
keywords: asthma; bronchial provocation tests; mannitol; respiratory function tests; spirometry