Mannitol vs Citric Acid Provocation

22 Oct Mannitol vs Citric Acid Provocation

The Mannitol Challenge has been a staple of lung function testing in recent times. This Bronchial Provocation test is fatiguing and challenging, however, very important in clinical diagnosis. It is used in medical screenings for asthma, and is the only pulmonary function test that can be performed which will definitively rule in or out asthma. However, could a different substance now be the key ingredient for this test?

Citric acid has more recently been used in the place of Mannitol to induce the symptoms of bronchial provocation. This test was shown to be equally as sensitive for lung function analysis as the Mannitol, and was also tolerated far better than the sugar-type substance. More patients failed to complete the Mannitol challenge due to excessive coughing, than they did with the Citric Acid.

So, for those who have endured the Mannitol Challenge – next time it could be the beautifully bitter taste of citric acid testing your lung function!


Nurmi, H., Latti, A., Brannan, J., & Koskela, H. (2019). Comparison of mannitol and citric acid cough provocation tests. Elsevier, 14-20.