The bronchial response to mannitol is attenuated by a previous methacholine test: but not vice versa

Clin Exp Allergy. 2009 Jul;39(7):966-71. doi: 10.1111/j.1365-2222.2009.03274.x. Epub 2009 May 20.


Aim: To examine the airway response to inhaled mannitol performed before or after a methacholine challenge test in a group of asthmatics with different levels of disease.

Methods: A total of 48 asthmatics, 18-73 years of age, were included in the study. Two pairs of challenges were performed in a random order on two separate days > or =24 h apart: either with mannitol performed first on day one, followed > or =1 h by methacholine, and methacholine as the first on day two, followed > or =1 h by mannitol or vice versa. A questionnaire-based interview was performed and lung function, exhaled nitric oxide, skin prick test, and blood eosinophil count were measured.

Results: A total of 44% of the asthmatics used inhaled corticosteroids and 48% were atopic. The airway response to mannitol was attenuated when mannitol was given after methacholine, compared with the response to mannitol when it was given first [log response dose ratio (RDR): 1.42 vs. 1.60 (P=0.004)], whereas the response to methacholine was unchanged in the opposite test order [log RDR: 0.81 vs. 0.96 (P=0.102)].

Conclusion: Bronchial challenges with inhaled mannitol and methacholine may be performed on the same day but provocation with mannitol should be performed before methacholine.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adult
  • Aged
  • Asthma / diagnosis*
  • Asthma / immunology
  • Asthma / physiopathology
  • Bronchi / drug effects*
  • Bronchi / immunology
  • Bronchial Hyperreactivity / diagnosis*
  • Bronchial Hyperreactivity / immunology
  • Bronchial Hyperreactivity / physiopathology
  • Bronchial Provocation Tests / methods*
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Mannitol / administration & dosage
  • Mannitol / adverse effects*
  • Mannitol / immunology
  • Methacholine Chloride* / immunology
  • Middle Aged
  • Surveys and Questionnaires
  • Young Adult


  • Methacholine Chloride
  • Mannitol