Prediction of treatment-response to inhaled corticosteroids by mannitol-challenge test in COPD. A proof of concept

Response to Add-on Inhaled Corticosteroids in COPD Based on Airway Hyperresponsiveness to Mannitol

“…7 In our previous proof-of-concept study in which 30 steroidnaive subjects with mild to moderate COPD were challenged with mannitol, AHR to mannitol was present in seven subjects (23%), five of whom showed fi both a reduction in AHR to mannitol and a signifi-fi cant improvement in FEV 1 and quality of life after ICS treatment. 8 Spirometry, however, remained unchanged in the absence of AHR. 8 To further investigate the potential predictive value of AHR to mannitol and response to ICS in mild to moderate COPD, we performed a double-blind, double-dummy, placebocontrolled trial of 3 months treatment with ICS in subjects already receiving tiotropium.…”

“…Based on the results of our pilot study, 8 we expected to observe an improvement in FEV 1 % predicted of 12% in the mannitolpositive group compared to the mannitol-negative group. A sample size of at least 10 subjects in each group was required to complete the study.…”

Bronchial hyperresponsiveness as a phenotypic feature of chronic obstructive pulmonary disease

“…Так, у таких пациентов в тесте с маннитолом через 3 мес. лечения иГКС произошел прирост до бронходилатационного ОФВ 1 в среднем на 12 %, тогда как у пациентов с отрицательным результатом теста подобная динамика отсутствовала [25].…”

Diagnostic and therapeutic value of airway challenges in asthma

“…The fi rst and most obvious is in the evaluation of patients with suspected EIB either clinically or in situations in which this is important, such as international athletic competitions, enrollment in the Armed Forces or police forces, or for SCUBA diving certifi cation. Indirect challenges are also of value in differentiating asthma from chronic airfl ow limitation [18,33,34] and in identifying an asthmatic (ie, corticosteroid-responsive) component in conjunction with chronic airfl ow limitation [43].…”

“…However, further studies are necessary to validate this approach. Indirect AHR (mannitol) can be used to predict corticosteroid responsiveness in individuals with chronic airfl ow limitation [43].…”