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Airway hyperresponsiveness to mannitol in relation to inspiratory and expiratory resistance in subjects with asthma, COPD, and healthy smokers

Nasr, Abir LU ; Papapostolou, Georgia LU orcid ; Jarenbäck, Linnea LU ; Romberg, Kerstin LU ; Tunsäter, Alf LU ; Ankerst, Jaro LU orcid ; Bjermer, Leif LU and Tufvesson, Ellen LU (2025) In European clinical respiratory journal 12(1). p.1-12
Abstract
Background
Airway hyperresponsiveness (AHR), a key feature of asthma, leads to airway narrowing in response to bronchoconstrictor stimuli. Notably, AHR is also observed in individuals with chronic obstructive pulmonary disease (COPD). The Mannitol challenge test is an indirect method to assess airway hyperresponsiveness.

Objective
The primary aim of this study was to explore airway hyperresponsiveness to mannitol in subjects with asthma and COPD regarding inspiratory and expiratory resistance and reactance. A secondary aim was to investigate fractional exhaled nitric oxide (FeNO), blood eosinophils, allergen sensitization, and symptom scores concerning airway hyperresponsiveness to mannitol.

Methods
The... (More)
Background
Airway hyperresponsiveness (AHR), a key feature of asthma, leads to airway narrowing in response to bronchoconstrictor stimuli. Notably, AHR is also observed in individuals with chronic obstructive pulmonary disease (COPD). The Mannitol challenge test is an indirect method to assess airway hyperresponsiveness.

Objective
The primary aim of this study was to explore airway hyperresponsiveness to mannitol in subjects with asthma and COPD regarding inspiratory and expiratory resistance and reactance. A secondary aim was to investigate fractional exhaled nitric oxide (FeNO), blood eosinophils, allergen sensitization, and symptom scores concerning airway hyperresponsiveness to mannitol.

Methods
The Mannitol challenge test was conducted on 292 subjects: 238 with asthma, 25 with COPD, 14 healthy smokers, and 15 healthy never-smokers. The response was assessed using both spirometry and respiratory oscillometry, with inspiratory and expiratory resistance and reactance measured separately.

Results
A positive mannitol test was confirmed in 84 (35%) subjects with asthma, 13 (52%) with COPD, and 7 (50%) of healthy smokers. Subjects with asthma who had a positive mannitol test had a higher inspiratory R5 and R19 at baseline, and also greater change in both inspiratory and expiratory R5, R5-R19, and X5 (but not R19), compared to asthma subjects with a negative test. A similar tendency was seen among subjects with COPD and healthy smokers. Subjects with asthma with a positive mannitol test had more symptoms than subjects with a negative test (median 21 versus 22; p = 0.036).

Conclusion
Inspiratory resistance, as measured by respiratory oscillometry, was shown to predict hyperresponsiveness to mannitol in asthma patients. Furthermore, respiratory oscillometry revealed a significant increase in resistance, primarily in the peripheral airways, following a mannitol challenge in these subjects. Integrating resistance and reactance measurements, along with traditional spirometry may offer a more comprehensive understanding of the hyperreactive airway response. (Less)
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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European clinical respiratory journal
volume
12
issue
1
article number
2546677
pages
1 - 12
publisher
Taylor & Francis
external identifiers
  • pmid:40860456
  • scopus:105014105140
ISSN
2001-8525
DOI
10.1080/20018525.2025.2546677
language
English
LU publication?
yes
id
d22732ed-3b6d-4187-b7fb-2370b1e884f9
date added to LUP
2025-09-21 17:47:29
date last changed
2025-09-23 03:05:35
@article{d22732ed-3b6d-4187-b7fb-2370b1e884f9,
  abstract     = {{Background<br/>Airway hyperresponsiveness (AHR), a key feature of asthma, leads to airway narrowing in response to bronchoconstrictor stimuli. Notably, AHR is also observed in individuals with chronic obstructive pulmonary disease (COPD). The Mannitol challenge test is an indirect method to assess airway hyperresponsiveness.<br/><br/>Objective<br/>The primary aim of this study was to explore airway hyperresponsiveness to mannitol in subjects with asthma and COPD regarding inspiratory and expiratory resistance and reactance. A secondary aim was to investigate fractional exhaled nitric oxide (FeNO), blood eosinophils, allergen sensitization, and symptom scores concerning airway hyperresponsiveness to mannitol.<br/><br/>Methods<br/>The Mannitol challenge test was conducted on 292 subjects: 238 with asthma, 25 with COPD, 14 healthy smokers, and 15 healthy never-smokers. The response was assessed using both spirometry and respiratory oscillometry, with inspiratory and expiratory resistance and reactance measured separately.<br/><br/>Results<br/>A positive mannitol test was confirmed in 84 (35%) subjects with asthma, 13 (52%) with COPD, and 7 (50%) of healthy smokers. Subjects with asthma who had a positive mannitol test had a higher inspiratory R5 and R19 at baseline, and also greater change in both inspiratory and expiratory R5, R5-R19, and X5 (but not R19), compared to asthma subjects with a negative test. A similar tendency was seen among subjects with COPD and healthy smokers. Subjects with asthma with a positive mannitol test had more symptoms than subjects with a negative test (median 21 versus 22; p = 0.036).<br/><br/>Conclusion<br/>Inspiratory resistance, as measured by respiratory oscillometry, was shown to predict hyperresponsiveness to mannitol in asthma patients. Furthermore, respiratory oscillometry revealed a significant increase in resistance, primarily in the peripheral airways, following a mannitol challenge in these subjects. Integrating resistance and reactance measurements, along with traditional spirometry may offer a more comprehensive understanding of the hyperreactive airway response.}},
  author       = {{Nasr, Abir and Papapostolou, Georgia and Jarenbäck, Linnea and Romberg, Kerstin and Tunsäter, Alf and Ankerst, Jaro and Bjermer, Leif and Tufvesson, Ellen}},
  issn         = {{2001-8525}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{1}},
  pages        = {{1--12}},
  publisher    = {{Taylor & Francis}},
  series       = {{European clinical respiratory journal}},
  title        = {{Airway hyperresponsiveness to mannitol in relation to inspiratory and expiratory resistance in subjects with asthma, COPD, and healthy smokers}},
  url          = {{http://dx.doi.org/10.1080/20018525.2025.2546677}},
  doi          = {{10.1080/20018525.2025.2546677}},
  volume       = {{12}},
  year         = {{2025}},
}