By E. Sapey
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The limitations of the mannitol test are related to the availability of the medications, and also the response from the patients. Since mannitol testing is a form of indirect testing by Bronchial Challenge Testing 31 monitoring a physiological response, it can be negative in patients with well-controlled asthma. This feature can be used clinically, as a mannitol challenge test, similar to an exercise, and hypertonic saline challenge test can be negative in patients whose asthma is very well controlled.
The FEV1 is measured at 30 and 90 seconds after completed inhalation. The percentage decline in FEV1 is calculated and the test is stopped 24 Bronchial Asthma – Emerging Therapeutic Strategies when a drop of 20% in FEV1 occurs, or the highest concentration is administered. The PC20 can be calculated from a log concentration vs. dose response curve. The two methods were previously believed to give similar results based on a single study with small numbers using histamine. More recently it has been shown that the tidal breathing method can produce a lower PC20.
This is highly likely to relate to the chronicity of the problem and may therefore be absent in those with recent onset of their disease or alternatively in those with chronic asthma and fixed airflow obstruction with airways remodelling. AHR can also have significant variability within a subject. This is important to acknowledge, particularly in children where the presence of a negative direct bronchial challenge may be heavily dependent on recent exposures. There are other factors that need to be taken into consideration when interpreting the MCT; firstly the pre-test probability, the interpretation of the results may be different depending Bronchial Challenge Testing 25 on whether you are screening an asymptomatic population or testing on the basis of symptoms.