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Mannitol versus hypertonic saline: Safety and efficacy of mannitol and hypertonic saline in sputum induction and bronchial hyperreactivity assessment.
Chron Respir Dis 2015; 12(3):197-203CR

Abstract

Eosinophilic asthma phenotype predicts good response to corticosteroids and associates to asthmatic exacerbations. Sputum induction by hypertonic saline (HS) inhalation is technically demanding. Bronchial hyperresponsiveness (BHR) to osmotic agents indirectly mirrors active airway inflammation. We compared the safety and ability of HS and mannitol to induce sputum and measure BHR. We evaluated the stability of inflammatory phenotypes. We studied 35 non-smoking asthmatics randomized to undergo HS and mannitol challenges on 2 days 1 week apart. Sputum was sampled for cell analysis and phenotyped as eosinophilic (≥3% eosinophils) and non-eosinophilic (<3%) asthma. Nineteen subjects had BHR to mannitol and nine of them also had BHR to HS. Drops in forced expiratory volume in 1 s were higher from HS challenge than from mannitol challenge. Adequate sputum samples were obtained from 80% subjects (68% mannitol and 71% HS). Eosinophils and macrophages from both challenges correlated. Neutrophils were higher in sputum from HS. Ninety percent samples were equally phenotyped with HS and mannitol. Fractional exhaled nitric oxide, sputum eosinophils and BHR correlated in both challenges. HS and mannitol showed similar capacity to produce valuable sputum samples. BHR to both osmotic stimuli partially resembled airway eosinophilic inflammation but mannitol was more sensitive than HS to assess BHR. Eosinophilic phenotype remained stable in most patients with both stimuli.

Authors+Show Affiliations

Departamento de Alergología, NavarraBiomed, Complejo Hospitalario de Navarra, Pamplona, Spain CIBERES, Complejo Hospitalario de Navarra, Pamplona, Spain mj.alvarez.puebla@cfnavarra.es.Departamento de Alergología, NavarraBiomed, Complejo Hospitalario de Navarra, Pamplona, Spain CIBERES, Complejo Hospitalario de Navarra, Pamplona, Spain.Departamento de Anatomía Patológica, NavarraBiomed, Complejo Hospitalario de Navarra, Pamplona, Spain.Departamento de Anatomía Patológica, NavarraBiomed, Complejo Hospitalario de Navarra, Pamplona, Spain.Departamento de Alergología, NavarraBiomed, Complejo Hospitalario de Navarra, Pamplona, Spain.Departamento de Alergología, NavarraBiomed, Complejo Hospitalario de Navarra, Pamplona, Spain.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

25761367

Citation

Alvarez-Puebla, M J., et al. "Mannitol Versus Hypertonic Saline: Safety and Efficacy of Mannitol and Hypertonic Saline in Sputum Induction and Bronchial Hyperreactivity Assessment." Chronic Respiratory Disease, vol. 12, no. 3, 2015, pp. 197-203.
Alvarez-Puebla MJ, Olaguibel JM, Almudevar E, et al. Mannitol versus hypertonic saline: Safety and efficacy of mannitol and hypertonic saline in sputum induction and bronchial hyperreactivity assessment. Chron Respir Dis. 2015;12(3):197-203.
Alvarez-Puebla, M. J., Olaguibel, J. M., Almudevar, E., Echegoyen, A. A., Vela, C., & de Esteban, B. (2015). Mannitol versus hypertonic saline: Safety and efficacy of mannitol and hypertonic saline in sputum induction and bronchial hyperreactivity assessment. Chronic Respiratory Disease, 12(3), pp. 197-203. doi:10.1177/1479972315576144.
Alvarez-Puebla MJ, et al. Mannitol Versus Hypertonic Saline: Safety and Efficacy of Mannitol and Hypertonic Saline in Sputum Induction and Bronchial Hyperreactivity Assessment. Chron Respir Dis. 2015;12(3):197-203. PubMed PMID: 25761367.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mannitol versus hypertonic saline: Safety and efficacy of mannitol and hypertonic saline in sputum induction and bronchial hyperreactivity assessment. AU - Alvarez-Puebla,M J, AU - Olaguibel,J M, AU - Almudevar,E, AU - Echegoyen,A A, AU - Vela,C, AU - de Esteban,B, Y1 - 2015/03/11/ PY - 2015/3/13/entrez PY - 2015/3/13/pubmed PY - 2016/4/26/medline KW - Asthma KW - eosinophils KW - hypertonic saline KW - mannitol KW - phenotype KW - sputum SP - 197 EP - 203 JF - Chronic respiratory disease JO - Chron Respir Dis VL - 12 IS - 3 N2 - Eosinophilic asthma phenotype predicts good response to corticosteroids and associates to asthmatic exacerbations. Sputum induction by hypertonic saline (HS) inhalation is technically demanding. Bronchial hyperresponsiveness (BHR) to osmotic agents indirectly mirrors active airway inflammation. We compared the safety and ability of HS and mannitol to induce sputum and measure BHR. We evaluated the stability of inflammatory phenotypes. We studied 35 non-smoking asthmatics randomized to undergo HS and mannitol challenges on 2 days 1 week apart. Sputum was sampled for cell analysis and phenotyped as eosinophilic (≥3% eosinophils) and non-eosinophilic (<3%) asthma. Nineteen subjects had BHR to mannitol and nine of them also had BHR to HS. Drops in forced expiratory volume in 1 s were higher from HS challenge than from mannitol challenge. Adequate sputum samples were obtained from 80% subjects (68% mannitol and 71% HS). Eosinophils and macrophages from both challenges correlated. Neutrophils were higher in sputum from HS. Ninety percent samples were equally phenotyped with HS and mannitol. Fractional exhaled nitric oxide, sputum eosinophils and BHR correlated in both challenges. HS and mannitol showed similar capacity to produce valuable sputum samples. BHR to both osmotic stimuli partially resembled airway eosinophilic inflammation but mannitol was more sensitive than HS to assess BHR. Eosinophilic phenotype remained stable in most patients with both stimuli. SN - 1479-9731 UR - https://www.unboundmedicine.com/medline/citation/25761367/Mannitol_versus_hypertonic_saline:_Safety_and_efficacy_of_mannitol_and_hypertonic_saline_in_sputum_induction_and_bronchial_hyperreactivity_assessment_ L2 - http://journals.sagepub.com/doi/full/10.1177/1479972315576144?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -