Bronchial Provocation Testing: The Future

Sandra D. Anderson; John D. Brannan

Disclosures

Curr Opin Allergy Clin Immunol. 2011;11(1):46-52. 

In This Article

Physician Diagnosis of Asthma

The sensitivity and specificity of mannitol are currently being reported to identify a physician diagnosis of asthma (Table 1). A positive mannitol test is defined as a 15% fall in FEV1 at 635 mg or less or a 10% fall between consecutive doses.[2,3•,9••,46,47••] A high specificity to identify a physician diagnosis of asthma has been found in well defined groups and the number of false-positive tests is 5% or less.[46,47••] Whereas the sensitivity for mannitol to identify a physician diagnosis is lower than might be expected, it is important to recognize that the benefit of current treatment on BHR, a previous diagnosis, or the period of 'current asthma', has not always been taken into account when reporting the data. For example, the sensitivity of mannitol to identify a physician diagnosis of asthma increased from 59.8 to 89% when those taking inhaled steroids and negative to mannitol were excluded[46] (Table 1).

In addition to reporting sensitivity to mannitol, Sverrild et al. [47••] reported the area under the receiver operator curve of 0.89 [95% confidence interval (CI) 0.83–0.95] for the response-dose ratio (RDR) to mannitol (% fall divided by the cumulative dose to cause that fall) and diagnosis of current asthma. The RDR is an index of airway reactivity and is useful for making comparisons before or after a successful intervention (when a PD15 may not be obtained) or to compare responses between mannitol and percentage fall in FEV1 after exercise – also an index of reactivity.[3•,9••,23,24••] For these reasons RDR as well as PD15 is likely to be increasingly reported both for diagnosis and assessment.

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