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Mannitol challenge helps ease asthma symptoms

Treatment involving ‘mannitol challenge’ – in which a patient inhales increasing doses of dry powder – can bring significant improvements in symptoms and reliever use for people with asthma, a study concludes.

Researchers from the University of Dundee compared symptoms, reliever use and lung function for 119 patients with persistent asthma randomly split into two groups. In one group, steroids (ciclesonide) were titrated against mannitol airway hyper-responsiveness (AHR), while in the other group steroids were titrated against a control.

Time to first mild exacerbation was similar in the two groups, but there were 27% fewer exacerbations over 12 months in the AHR group. The final average daily ciclesonide dose was higher in AHR group than the control group, with no associated significant suppression or overnight urinary cortisol/creatinine.

The researchers’ paper, co-authored by Professor Brian Lipworth, professor of allergy and pulmonology, said:  ‘Mannitol challenge was well tolerated in a primary care setting. Significant improvements were seen within the AHR group, but not the control group for methacholine, salivary eosinophilic cationic protein, exhaled nitric oxide, symptoms and reliever use.’

Chest 2011, online  13 October