S M Lutfor Rahman, Bashir Ahmed, Md. Naimul Hoque, Md. Abdur Rouf,Mohammed Shahedur Rahman Khan, Md. Abu Raihan, Md. Khairul Hassan Jessy,Habib Uddin Ahmad, Md. Aminul Islam, Rustom Ali, Md. Rashidul Hassan

Abstract:
Introduction: Inhaled mannitol is a new bronchial provocation test (BPT)
developed to improve portability and standardization of osmotic challenge testing.
Osmotic challenge tests have an advantage over the traditional methods of
measuring airway hyper responsiveness using methacholine as they demonstrate
higher specificity to identify bronchial hyper responsiveness. The safety and the
efficacy of mannitol as a BPT to measure airway hyper responsiveness were
compared to hypertonic saline and methacholine (as gold standard) in people
both with and without signs and symptoms of asthma.
Methods: A double blind, randomized, crossover study was carried out in asthmatic
and non-asthmatic subjects. A total of 118 subjects were recruited and 107 subjects
completed at least the two studies (Mannitol and Hypertonic saline) and 75 subjects
completed all three studies. Mannitol was delivered using a low resistance dry
powder inhaler device; hypertonic saline and methacholine delivered using a
nebulizer. The FEV1 was measured 60 seconds after each dose of mannitol (5, 10,
20, 40, 80, 160, 160, 160mg) and after each exposure to hypertonic saline (4.5%,
9.0%, 13.5% and 18.0%) and methacholine (0.025, 0.25, 2.5, and 10.0 mg/ml). A
15% fall in FEV1 (PD15) defined a positive test for mannitol or hypertonic saline
(HS) and 20.0% fall in FEV1 (PC20) for methacholine (Anderson et al. 1997). Each
challenge was performed at least one week apart. Adverse events were monitored
and diaries kept for 7 days following the tests for monitoring the adverse events.
Results: The mean ages were 34.52±10.37 years and 34.15±9.45 years in asthmatic
patients and non-asthmatic subjects respectively, which was almost similar
between two groups. Majority of the study subjects belonged to 31 - 40 years of
age group in both groups that was 35.7% in asthmatic patients and 33.3% in nonasthmatic
subjects. Male was predominant in both group, which was 51.79% and
52.94% in asthmatic and non-asthmatic subjects respectively and male female

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