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Karantaglis N, Kirvassilis F, Hatziagorou E, Gkantaras A, Kontouli K, Tsanakas J, Emporiadou M. Mannitol Challenge to Assess Therapy Response in Asthmatic Children: An Interventional Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050802. [PMID: 37238350 DOI: 10.3390/children10050802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
Bronchial provocation tests, such as the mannitol challenge, can be performed to identify and quantify the severity of bronchial hyperresponsiveness in asthmatic patients. Studies of the mannitol challenge as a monitoring tool in asthmatic children are limited. Our primary aim was to compare the bronchial hyperresponsiveness to mannitol in treatment-naive asthmatic children between baseline and three months after receiving the indicated asthma prophylaxis. Twenty-three asthmatic patients aged 4-16 years were analyzed in this prospective cohort study. All subjects underwent the mannitol challenge at baseline and after three months of treatment with budesonide ± formoterol. The difference in the provocative dose of mannitol to induce a 15% drop in FEV1 (PD15) between baseline and follow-up, as well as its association with the presence of exercise-induced or nocturnal asthma symptoms, were evaluated. The PD15 value increased significantly post-treatment (228.5 mg [4.50-458.15]; p = 0.04). Independently of the evaluation time point, the PD15 values were significantly lower in the presence of nocturnal asthma symptoms (490 mg [122-635] vs. 635 mg [635-635]; p = 0.03), whereas there was no association between the PD15 value and the presence of exercise-induced asthma (p = 0.73). These results suggest that bronchial hyperresponsiveness to mannitol may be a potential monitoring tool in the pediatric asthmatic population, reflecting therapy response in children receiving prophylactic treatment.
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Affiliation(s)
- Nikolaos Karantaglis
- Pediatric Pulmonology and Cystic Fibrosis Unit, 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos Str. 49, 54642 Thessaloniki, Greece
| | - Fotios Kirvassilis
- Pediatric Pulmonology and Cystic Fibrosis Unit, 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos Str. 49, 54642 Thessaloniki, Greece
| | - Elpis Hatziagorou
- Pediatric Pulmonology and Cystic Fibrosis Unit, 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos Str. 49, 54642 Thessaloniki, Greece
| | - Antonios Gkantaras
- Pediatric Immunology and Rheumatology Referral Center, 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos Str. 49, 54642 Thessaloniki, Greece
| | - Kalliopi Kontouli
- Pediatric Pulmonology and Cystic Fibrosis Unit, 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos Str. 49, 54642 Thessaloniki, Greece
| | - John Tsanakas
- Pediatric Pulmonology and Cystic Fibrosis Unit, 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Konstantinoupoleos Str. 49, 54642 Thessaloniki, Greece
| | - Maria Emporiadou
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Klain A, Dinardo G, Salvatori A, Indolfi C, Contieri M, Brindisi G, Decimo F, Zicari AM, Miraglia del Giudice M. An Overview on the Primary Factors That Contribute to Non-Allergic Asthma in Children. J Clin Med 2022; 11:6567. [PMID: 36362795 PMCID: PMC9654665 DOI: 10.3390/jcm11216567] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 04/13/2024] Open
Abstract
The prevalence of non-allergic asthma in childhood is low, peaking in late adulthood. It is triggered by factors other than allergens, like cold and dry air, respiratory infections, hormonal changes, smoke and air pollution. In the literature, there are few studies that describe non-allergic asthma in pediatric age. Even though it is a less common disorder in kids, it is crucial to identify the causes in order to keep asthma under control, particularly in patients not responding to conventional treatments. In this review, we discuss non-IgE-mediated forms of asthma, collecting the latest research on etiopathogenesis and treatment.
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Affiliation(s)
- Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giulio Dinardo
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Alessandra Salvatori
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Marcella Contieri
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giulia Brindisi
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy
| | - Fabio Decimo
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Anna Maria Zicari
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy
| | - Michele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Molina C, Kaialy W, Nokhodchi A. The crucial role of leucine concentration on spray dried mannitol-leucine as a single carrier to enhance the aerosolization performance of Albuterol sulfate. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2018.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Attanasi M, Consilvio NP, Rapino D, Nicola MD, Scaparrotta A, Cingolani A, Petrosino MI, Filippo PD, Pillo SD, Chiarelli F. Bronchial hyperresponsiveness to mannitol, airway inflammation and Asthma Control Test in atopic asthmatic children. Arch Med Sci 2016; 12:137-44. [PMID: 26925129 PMCID: PMC4754374 DOI: 10.5114/aoms.2016.57589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/06/2014] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the relationship between airway hyperresponsiveness (AHR) to mannitol and bronchial inflammation measured as exhaled nitric oxide (FeNO) and to assess whether asthma control correlates with AHR to mannitol and FeNO in atopic asthmatic children. MATERIAL AND METHODS Allergy evaluation, the mannitol challenge test, FeNO levels and the Asthma Control Test (ACT) questionnaire were assessed in 40 children with intermittent and mild persistent allergic asthma. RESULTS All the subjects showed positive AHR to mannitol. Pearson's correlation test revealed a significant inverse correlation between AHR (mannitol PD15) and FeNO (p = 0.020). There was also a significant positive correlation between ACT and PD15 (p = 0.020) and a significant negative correlation between ACT and FeNO levels (p = 0.003). The study population was divided into two groups according to FeNO levels (group A ≥ 16 ppb vs. group B < 16 ppb). In group A mannitol PD15 was significantly lower (p = 0.040) and ACT score values were significantly lower (p = 0.001) compared to group B. In group A, the ACT showed that 13.3% of subjects had well-controlled asthma, 80% had partially controlled asthma and 6.7% had uncontrolled asthma. In group B, the ACT showed that 72% of subjects had well-controlled asthma and 28% had partially controlled asthma. CONCLUSIONS Our findings indicate that the degree of AHR to mannitol correlates with the degree of airway inflammation in asthmatic atopic children; moreover, better control of asthma correlates with a lower degree of AHR to both mannitol and FeNO.
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Affiliation(s)
- Marina Attanasi
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Nicola P. Consilvio
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Daniele Rapino
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Experimental and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Alessandra Scaparrotta
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Anna Cingolani
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Marianna I. Petrosino
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Paola Di Filippo
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
| | - Sabrina Di Pillo
- Department of Paediatrics, Allergy and Respiratory Diseases Clinic, University of Chieti, Chieti, Italy
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Attanasi M, Rapino D, Marcovecchio ML, Consilvio NP, Scaparrotta A, Cingolani A, Di Pillo S, Chiarelli F. Airway hyper-responsiveness to mannitol provides a good evaluation of atopy in childhood asthma. Acta Paediatr 2015; 104:718-23. [PMID: 25661794 DOI: 10.1111/apa.12968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 12/11/2014] [Accepted: 02/02/2015] [Indexed: 01/27/2023]
Abstract
AIM The relationship between airway hyper-responsiveness (AHR) and atopy has been previously investigated, but there are still some issues to be clarified. The aim of this study was to assess the link between AHR and mannitol and atopy in asthmatic children. METHODS We evaluated 44 children with asthma, aged 6-16 years of age, using skin prick tests (SPTs), serum total and specific immunoglobulin E (IgE) levels and the mannitol challenge test (MCT). RESULTS We found a good correlation between AHR to mannitol and specific IgE against Dermatophagoides pteronissinus (r = -0.66, p < 0.001) and a weak correlation with specific IgE against dog dander (r = -0.33, p = 0.01) and Aspergillus fumigatus (r = -0.23, p = 0.02). Furthermore, we found a weak correlation between AHR to mannitol and serum total IgE (r = -0.30; p = 0.03), the sum of specific IgE to aeroallergens (r = -0.37, p = 0.01) and the number of positive SPTs (r = -0.31, p = 0.02). CONCLUSION Measuring AHR with MCT might provide an accurate evaluation of the degree of atopy in children. The patients with a higher degree of atopy were significantly more reactive to mannitol. In clinical practice, these results indicate that children with asthma who are more atopic may require more intensive treatment strategies to reduce AHR.
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Affiliation(s)
- M Attanasi
- Allergy and Respiratory Diseases Clinic; Department of Paediatrics; University of Chieti; Chieti Italy
| | - D Rapino
- Allergy and Respiratory Diseases Clinic; Department of Paediatrics; University of Chieti; Chieti Italy
| | | | - N P Consilvio
- Allergy and Respiratory Diseases Clinic; Department of Paediatrics; University of Chieti; Chieti Italy
| | - A Scaparrotta
- Allergy and Respiratory Diseases Clinic; Department of Paediatrics; University of Chieti; Chieti Italy
| | - A Cingolani
- Allergy and Respiratory Diseases Clinic; Department of Paediatrics; University of Chieti; Chieti Italy
| | - S Di Pillo
- Allergy and Respiratory Diseases Clinic; Department of Paediatrics; University of Chieti; Chieti Italy
| | - F Chiarelli
- Department of Paediatrics; University of Chieti; Chieti Italy
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Barben J, Strippoli MPF, Trachsel D, Schiller B, Hammer J, Kuehni CE. Effect of mannitol dry powder challenge on exhaled nitric oxide in children. PLoS One 2013; 8:e54521. [PMID: 23349918 PMCID: PMC3548778 DOI: 10.1371/journal.pone.0054521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 12/12/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (FENO), a non-invasive marker of eosinophilic airway inflammation, is increasingly used for diagnostic and therapeutic decisions in adult and paediatric asthma. Standardized guidelines for the measurement of FENO recommend performing FENO measurements before rather than after bronchial provocation tests. OBJECTIVE To investigate whether FENO levels decrease after a Mannitol dry powder (MDP) challenge in a clinical setting, and whether the extent of the decrease is influenced by number of MDP manoeuvres, baseline FENO, atopy and doctor diagnosed asthma. METHODS Children aged 6-16 years, referred for possible reactive airway disease to a respiratory outpatient clinic, performed an MDP challenge (Aridol®, Pharmaxis, Australia). FENO was measured in doublets immediately before and after the challenge test using the portable NIOX MINO® device (Aerocrine, Stockholm, Sweden). We analysed the data using Kruskal-Wallis rank tests, Wilcoxon signed rank tests and multivariable linear regressions. RESULTS One hundred and seven children completed both tests (mean±SD age 11.5±2.8 years). Overall, median (interquartile range) FENO decreased slightly by -2.5 ppb (-7.0, -0.5), from 18.5 ppb (10.5, 45.5) before the MDP challenge to 16.5 ppb thereafter (8.5, 40.5; p<0.001). In all participants, the change in FENO was smaller than one standard deviation of the baseline mean. The % fall in FENO was smaller in children with less MDP manoeuvres (e.g. higher bronchial responsiveness; p = 0.08) but was not influenced by levels of baseline FENO (p = 0.68), atopy (p = 0.84) or doctor diagnosed asthma (p = 0.93). CONCLUSION MDP challenge test influences FENO values but differences are small and clinically barely relevant.
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Affiliation(s)
- Juerg Barben
- Department of Paediatric Pulmonology & Allergology, Children's Hospital, St. Gallen, Switzerland.
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Patrick LM, Demet I, Andreas J, Bruno K, Heinrich WJ, Alexander M. Comparison of treatment guidance based on bronchial responsiveness to mannitol, spirometry or exhaled nitric oxide in stable asthmatic children. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojped.2013.34074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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