Diagnostic properties of the methacholine and mannitol bronchial challenge tests: A comparison study

Min Hye Kim, Woo Jung Song, Tae Wan Kim, Hyun Jung Jin, You Seob Sin, Young Min Ye, Sang Heon Kim, Heung Woo Park, Byung Jae Lee, Hae Sim Park, Ho Joo Yoon, Dong Chull Choi, Kyung Up Min, Sang Heon Cho

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Background and 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. Methacholine and mannitol bronchial challenge are two representative tests for asthma. However, their difference has not been directly evaluated among Korean adults. We compared the diagnostic properties of these two tests. Two diagnostic tests showed similar diagnostic properties, but also suggested their intercomplementary roles for asthma.

Original languageEnglish
Pages (from-to)852-856
Number of pages5
JournalRespirology
Volume19
Issue number6
DOIs
StatePublished - Aug 2014

Keywords

  • bronchial provocation test
  • mannitol
  • methacholine
  • sensitivity
  • specificity.

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