Mannitol challenge testing for asthma in a community cohort of young adults

White, Elisha C., de Klerk, Nicholas, Hantos, Zoltan, Priston, Monique, Hollams, Elysia M., James, Alan, Sly, Peter D., Holt, Patrick G. and Hall, Graham L. (2017) Mannitol challenge testing for asthma in a community cohort of young adults. Respirology, 22 4: 678-683. doi:10.1111/resp.12955


Author White, Elisha C.
de Klerk, Nicholas
Hantos, Zoltan
Priston, Monique
Hollams, Elysia M.
James, Alan
Sly, Peter D.
Holt, Patrick G.
Hall, Graham L.
Title Mannitol challenge testing for asthma in a community cohort of young adults
Journal name Respirology   Check publisher's open access policy
ISSN 1440-1843
1323-7799
Publication date 2017-05-01
Year available 2016
Sub-type Article (original research)
DOI 10.1111/resp.12955
Open Access Status Not yet assessed
Volume 22
Issue 4
Start page 678
End page 683
Total pages 6
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Subject 2740 Pulmonary and Respiratory Medicine
Abstract Background and objective: 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. Methods: 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. Results: 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%. Conclusion: 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.
Formatted abstract
Background and objective: 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.

Methods: 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.

Results: 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%.

Conclusion: 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.
Keyword Asthma
Bronchial provocation tests
Mannitol
Respiratory function tests
Spirometry
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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