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Relationship between airway responsiveness to mannitol and to methacholine and markers of airway inflammation, peak flow variability and quality of life in asthma patients.
Clin Exp Allergy. 2008 Jan; 38(1):43-50.CE

Abstract

BACKGROUND

Airway hyperresponsiveness (AHR) to stimuli that cause bronchial smooth muscle (BSM) contraction indirectly through the release of endogenous mediators is thought to reflect airway inflammation more closely compared with AHR measured by stimuli that act directly on BSM.

METHODS

Fifty-three adult non-smoking asthmatics (28 females, 18-56 years) who were not taking inhaled steroids were challenged with mannitol (up to 635 mg) and methacholine (up to 8 mumol). Induced sputum eosinophils, exhaled nitric oxide (eNO), peak flow variation and clinical severity of asthma according to the Global Initiative for Asthma guidelines were measured in addition to the health-related quality-of-life score using the Juniper asthma quality-of-life questionnaire.

FINDINGS

Both AHR to mannitol as well as to methacholine was associated with elevated markers of airway inflammation: in 83% of asthma patients with AHR to mannitol, and in 88% of asthma patients with AHR to methacholine, the eNO level was >20 p.p.b. Sputum% eosinophils >1% was measured in 70% of asthma patients with AHR to mannitol and in 77% of asthma patients with AHR to methacholine. In asthma patients without AHR, 15% had an eNO level >20 p.p.b., but none had sputum% eosinophils >1%. AHR to mannitol was more closely associated with the percentage of sputum eosinophils (PD(15) to mannitol vs. sputum% eosinophils: r: -0.52, P<0.05), compared with AHR to methacholine (PD(20) to methacholine vs. sputum% eosinophils: r: -0.28, NS). Furthermore, there was a stronger correlation between AHR to mannitol and the level of eNO [PD(15) to mannitol vs. eNO (p.p.b.): r: -0.63, P<0.001], compared with AHR to methacholine [PD(20) to methacholine vs. eNO (p.p.b.): r: -0.43, P<0.05].

INTERPRETATION

In asthma patients not being treated with steroids, AHR to mannitol and to methacholine indicated the presence of airway inflammation. AHR to mannitol reflected the degree of airway inflammation more closely when compared with methacholine.

Authors+Show Affiliations

Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg Hospital, University Hospital of Copenhagen, Copenhagen NV, Denmark. Porsbjerg@dadlnet.dkNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18028458

Citation

Porsbjerg, C, et al. "Relationship Between Airway Responsiveness to Mannitol and to Methacholine and Markers of Airway Inflammation, Peak Flow Variability and Quality of Life in Asthma Patients." Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, vol. 38, no. 1, 2008, pp. 43-50.
Porsbjerg C, Brannan JD, Anderson SD, et al. Relationship between airway responsiveness to mannitol and to methacholine and markers of airway inflammation, peak flow variability and quality of life in asthma patients. Clin Exp Allergy. 2008;38(1):43-50.
Porsbjerg, C., Brannan, J. D., Anderson, S. D., & Backer, V. (2008). Relationship between airway responsiveness to mannitol and to methacholine and markers of airway inflammation, peak flow variability and quality of life in asthma patients. Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, 38(1), 43-50.
Porsbjerg C, et al. Relationship Between Airway Responsiveness to Mannitol and to Methacholine and Markers of Airway Inflammation, Peak Flow Variability and Quality of Life in Asthma Patients. Clin Exp Allergy. 2008;38(1):43-50. PubMed PMID: 18028458.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship between airway responsiveness to mannitol and to methacholine and markers of airway inflammation, peak flow variability and quality of life in asthma patients. AU - Porsbjerg,C, AU - Brannan,J D, AU - Anderson,S D, AU - Backer,V, Y1 - 2007/11/19/ PY - 2007/11/22/pubmed PY - 2008/2/2/medline PY - 2007/11/22/entrez SP - 43 EP - 50 JF - Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology JO - Clin Exp Allergy VL - 38 IS - 1 N2 - BACKGROUND: Airway hyperresponsiveness (AHR) to stimuli that cause bronchial smooth muscle (BSM) contraction indirectly through the release of endogenous mediators is thought to reflect airway inflammation more closely compared with AHR measured by stimuli that act directly on BSM. METHODS: Fifty-three adult non-smoking asthmatics (28 females, 18-56 years) who were not taking inhaled steroids were challenged with mannitol (up to 635 mg) and methacholine (up to 8 mumol). Induced sputum eosinophils, exhaled nitric oxide (eNO), peak flow variation and clinical severity of asthma according to the Global Initiative for Asthma guidelines were measured in addition to the health-related quality-of-life score using the Juniper asthma quality-of-life questionnaire. FINDINGS: Both AHR to mannitol as well as to methacholine was associated with elevated markers of airway inflammation: in 83% of asthma patients with AHR to mannitol, and in 88% of asthma patients with AHR to methacholine, the eNO level was >20 p.p.b. Sputum% eosinophils >1% was measured in 70% of asthma patients with AHR to mannitol and in 77% of asthma patients with AHR to methacholine. In asthma patients without AHR, 15% had an eNO level >20 p.p.b., but none had sputum% eosinophils >1%. AHR to mannitol was more closely associated with the percentage of sputum eosinophils (PD(15) to mannitol vs. sputum% eosinophils: r: -0.52, P<0.05), compared with AHR to methacholine (PD(20) to methacholine vs. sputum% eosinophils: r: -0.28, NS). Furthermore, there was a stronger correlation between AHR to mannitol and the level of eNO [PD(15) to mannitol vs. eNO (p.p.b.): r: -0.63, P<0.001], compared with AHR to methacholine [PD(20) to methacholine vs. eNO (p.p.b.): r: -0.43, P<0.05]. INTERPRETATION: In asthma patients not being treated with steroids, AHR to mannitol and to methacholine indicated the presence of airway inflammation. AHR to mannitol reflected the degree of airway inflammation more closely when compared with methacholine. SN - 1365-2222 UR - https://www.unboundmedicine.com/medline/citation/18028458/Relationship_between_airway_responsiveness_to_mannitol_and_to_methacholine_and_markers_of_airway_inflammation_peak_flow_variability_and_quality_of_life_in_asthma_patients_ DB - PRIME DP - Unbound Medicine ER -