Subbarao P, Brannan J D, Ho B, Anderson S D, Chan H K, Coates A L
Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Pediatr Pulmonol. 2000 Apr;29(4):291-8. doi: 10.1002/(sici)1099-0496(200004)29:4<291::aid-ppul9>3.0.co;2-a.
Inhaled mannitol has been developed for bronchial challenge testing in adults. This study determined if mannitol could identify children with active asthma and responsive to methacholine, and whether mannitol challenge was faster to complete than methacholine challenge. Twenty-five children (aged 6-13 years) responsive to methacholine and 10 nonasthmatic children unresponsive to methacholine were studied. The methacholine challenge (Cockcroft protocol) was followed by a mannitol challenge on separate days. Twenty-one asthmatic children were positive to mannitol. Three taking inhaled corticosteroids with borderline methacholine responsiveness did not respond to mannitol, and one could not complete the mannitol challenge due to cough. The geometric mean (GM) and 95% confidence interval (CI) for PD(15) for mannitol was 39 mg (19, 78), and PC(20) for methacholine was 0.6 mg/mL (0.35-1.02) (r(p) = 0.75, p < 0.001, n = 21). Responses to mannitol were repeatable: GM PD(15) for the first challenge was 29 mg (CI: 17,50), and for the second challenge, 33 mg (CI: 20, 55) (P = 0.44, n = 9). Mannitol was faster to administer than methacholine (median (range)) 14 min (5-32) vs. 29 min (19-49), respectively (P < 0.001). Time to recover to baseline FEV(1) spontaneously and after bronchodilator administration was similar for both challenges. There were no significant falls in arterial oxygen saturations. During mannitol challenge, the mean (SD) fall in FEV(1) in nonasthmatic children was 3.1% (2.9). We conclude that mannitol identifies children with airway hyperresponsiveness and is faster to perform than the methacholine challenge.
吸入用甘露醇已被开发用于成人支气管激发试验。本研究旨在确定甘露醇是否能识别出患有活动性哮喘且对乙酰甲胆碱有反应的儿童，以及甘露醇激发试验是否比乙酰甲胆碱激发试验完成得更快。研究了25名对乙酰甲胆碱有反应的儿童（6 - 13岁）和10名对乙酰甲胆碱无反应的非哮喘儿童。在不同日期，先进行乙酰甲胆碱激发试验（科克罗夫特方案），随后进行甘露醇激发试验。21名哮喘儿童对甘露醇呈阳性反应。3名正在使用吸入性糖皮质激素且乙酰甲胆碱反应临界的儿童对甘露醇无反应，1名因咳嗽无法完成甘露醇激发试验。甘露醇的PD(15)几何均值（GM）和95%置信区间（CI）为39毫克（19, 78），乙酰甲胆碱的PC(20)为0.6毫克/毫升（0.35 - 1.02）（r(p) = 0.75，p < 0.001，n = 21）。对甘露醇的反应是可重复的：第一次激发试验的GM PD(15)为29毫克（CI：17, 50），第二次激发试验为33毫克（CI：20, 55）（P = 0.44，n = 9）。甘露醇给药比乙酰甲胆碱更快（中位数（范围）），分别为14分钟（5 - 32）和29分钟（19 - 49）（P < 0.001）。两种激发试验后自发恢复到基线FEV(1)以及使用支气管扩张剂后恢复到基线FEV(1)的时间相似。动脉血氧饱和度没有显著下降。在甘露醇激发试验期间，非哮喘儿童FEV(1)的平均（标准差）下降为3.1%（2.9）。我们得出结论，甘露醇可识别气道高反应性儿童，且比乙酰甲胆碱激发试验执行得更快。
