Thoracic & Sleep Group

Bronchial Provocation (Mannitol)

Precise bronchial provocation testing with mannitol.

Important Information About The Test

During the test you will inhale Mannitol – which is a sugary powder. Between doses you will perform spirometry (a simple breathing test) to assess how your airways respond to the Mannitol. It is important that you do not take certain medications prior to your test – please refer to the following table. If you feel you need to take your medications do not hesitate to take them, and call us to reschedule your test appointment.

Protocol

At the start of the test you will be asked to blow into a spirometer which is a machine that measures how fast and how much air you can blow out. You will then inhale a fine powder from an inhaler. The powder is 100% mannitol (a naturally occurring sugar). The spirometer test is repeated after you inhale each dose of the powder and a measurement is taken and compared to the initial spirometer result.

Medications to stop before your test

It is important that these medications NOT be used prior to the test. Please look at the following list – if you are unsure, please contact the TSGQ Laboratory performing the test.

Withholding Time

Medication

6 – 8 hours

Inhaled Nonsteroidal Anti-Inflammatory Agents: cromolyn sodium (Intal®); nedocromil sodium (TILADE®)

8 hours

Short-Acting Bronchodilators: Salbutamol (Ventolin®, Asmol®, Airomir®), albuterol (ProAir®), terbutaline sulfate (Bricanyl®)

12 hours

Inhaled Corticosteroids: beclomethasone dipropionate (Qvar®); budesonide (Pulmicort®); fluticasone propionate (Flixotide®, Fluticasone Cipla®), ciclesonide (Alvesco®)

Anticholinergic Bronchodilators: ipratropium bromide (Atrovent®)

24 hours

Inhaled Corticosteroids And Long-Acting Beta2 Agonists Combination Products: fluticasone propionate and salmeterol (Seretide®, Cipla®); budesonide and formoterol fumarate dehydrate (Symbicort®, DuoResp Spiromax®), Fluticasone furoate/vilanterol (Breo Ellipta®)

Long-Acting Bronchodilators: salmeterol xinafoate (Serevent®); formoterol fumarate (Oxis®), idacaterol (Onbrez®)

Phosphodiesterase Inhibitors / Adenosine Receptors Theophyllines

72 hours

Long-acting Muscarinic Antagonists: triotropium bromide (Spiriva®), aclidinium (Bretaris Genuair®), glycopyrronium (Seebri®), umeclidinium (Incruse Ellipta®)

Antihistamines: Over-the-Counter & Prescription brompheniramine maleate (Dimetapp®); diphenhydramine (Benadryl®); loratadine (Claritin®); cetirizine (Zyrtec®); fexofenadine (Allegra®); levocetirizine dihydrochlride (Xyzel®)

Long-Acting Muscarinic Antagonist/Long-Acting Beta2 Agonist combination: tiotropium/olodaterol (Spiolto®), aclidinium/formoterol (Brimica Genuair®), idacaterol/gycopyrronium (Ultibro Breezhaler®), umeclidinium/vilanterol (Anoro Ellipta®)

Fluticasone/umeclidinium/vilanterol (Trelegy Ellipta®)

Cold and Flu tablets

Nasal sprays: such as Nasonex Allergy®, Rhinocort®, Flixonase®, Avamys®, Beconase®, Omnaris®

4 Days

Leukotriene-Receptor Antagonists montelukast sodium (Singulair®, Montelukast®)

Day of Test

Refrain from the following:

-Caffeine-containing foods: coffee, tea, cola drinks, chocolate, etc.

-Vigorous exercise

-Smoking at least six hours prior to testing

Risks of the bronchial provocation test

In recommending this procedure your doctor has balanced the benefits and risks of the procedure against the benefits and risks of not proceeding. Your doctor believes there is a net benefit to you going ahead.

The risks/complications of this procedure are;

Common risks (more than 5%) include;

  • Mild shortness of breath (feeling puffed)
  • Coughing
  • Feeling tight in the chest or wheezing.

Rare risks (less than 1%) include;

  • Severe asthma attack

All of these symptoms can be treated with medication. Death as a result of this procedure is extremely rare.

Precautions

Do not take a bronchoprovocation test if you have an allergy to:

  • Mannitol or any of the ingredients contained in the capsule shell. These are gelatin, titanium dioxide, yellow iron oxide and red iron oxide.
  • if you now have or used to have a swollen or weakened blood vessel around the heart or brain (aneurysm);
  • if you have high blood pressure which is not controlled by medicine;
  • if you have had a heart attack in the last 6 months;
  • if you have had a stroke in the last 6 months.
  • If you are unsure about whether you should do this Mannitol challenge test, talk to your testing scientist.

 

The test takes approximately 60 minutes.