Swiebocka Ewa M, Siergiejko Grzegorz, Siergiejko Zenon
Pediatrics, Gastroenterology and Allergology Department, University Children Hospital, Medical University of Bialystok, Bialystok, Poland.
J Asthma. 2012 Oct;49(8):817-21. doi: 10.3109/02770903.2012.717660.
The aim of this study was to compare the usefulness of mannitol provocation test to that of classical histamine challenge in children with PC(20)FEV(1) histamine lower than 4 mg/ml.
Twenty-two adolescent patients (mean age of 15.4 ± 4.1 years) with established asthma (PC(20)FEV(1) histamine below 4 mg/ml) were included in this study. Bronchial challenge with mannitol was performed 1-2 days after the test with histamine.
The fraction of positive results of mannitol test was markedly lower when compared with the histamine challenge (72.7% vs. 100%, p = .015). The test was discontinued in one case due to severe coughing after inhalation of 315 mg of mannitol. Coughing during inhalation of dry mannitol powder occurred in most patients, although drinking water after subsequent doses alleviated this symptom in nearly all of them. Of note, triboelectrification of the inhaler and capsules was observed during the administration of consecutive mannitol doses, markedly hindering the delivery of this provoking agent. The relative decrease in FEV(1) resulting from bronchial provocation was significantly lower following mannitol delivery when compared with the histamine test (70.3% vs. 81.6% of resting value, p < .001). Significant correlation was not observed between the values of PC(20)FEV(1) histamine and PD(15)FEV(1) mannitol levels.
Bronchial challenge with mannitol can be used as a screening test in everyday practice, but one cannot exclude bronchial hyperresponsiveness based on its negative results. Moreover, its usefulness is limited by the influence of static on the delivery of sequential mannitol doses and coughing which can be often associated with mannitol inhalation.
本研究旨在比较甘露醇激发试验与经典组胺激发试验在PC(20)FEV(1)组胺低于4mg/ml的儿童中的效用。
本研究纳入了22例确诊哮喘（PC(20)FEV(1)组胺低于4mg/ml）的青少年患者（平均年龄15.4±4.1岁）。在组胺试验后1-2天进行甘露醇支气管激发试验。
与组胺激发试验相比，甘露醇试验的阳性结果比例显著更低（72.7%对100%，p = 0.015）。1例患者在吸入315mg甘露醇后因严重咳嗽而终止试验。大多数患者在吸入干燥甘露醇粉末时出现咳嗽，不过随后饮水几乎缓解了所有患者的该症状。值得注意的是，在连续给予甘露醇剂量的过程中观察到吸入器和胶囊产生摩擦起电，显著阻碍了这种激发剂的递送。与组胺试验相比，给予甘露醇后支气管激发导致的FEV(1)相对下降显著更低（为静息值的70.3%对81.6%，p < 0.001）。未观察到PC(20)FEV(1)组胺值与PD(15)FEV(1)甘露醇水平之间存在显著相关性。
甘露醇支气管激发试验可在日常实践中用作筛查试验，但不能基于其阴性结果排除支气管高反应性。此外，其效用受到静电对连续甘露醇剂量递送的影响以及咳嗽（常与甘露醇吸入相关）的限制。
