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Bronchial Challenge Tests: - Mannitol Challenge

Bronchial Challenge tests: - Mannitol Challenge

The Mannitol Challenge is a test to see if you have airways sensitivity or not. Airways sensitivity may be caused by inflammation of the airways, making it difficult to breathe sometimes. The Mannitol is a naturally occurring sugar alcohol found in vegetables and fruits. It is used as a pharmaceutical excipient and a food additive and also approved as a bulk sweetener. A trained Respiratory Physiologist will ask you to breathe in the mannitol, using a small inhaler. As part of the test, you will be asked to blow into a tube that will measure the effect of this substance on your lungs. This medicine is only used to see whether you have airways sensitivity.

Test Duration



Approximately 60 minutes


Test Preparation



You may generally continue with your normal routine. However, there are some points to note to improve comfort and ensure accurate results:

Some Drugs will interfere with the Mannitol Challenge. Please do not take the following medication before the test:

  • Inhaled non-steroidal anti-inflammatory agents 6-8 hours prior testing
  • Salbutamol, Salamol (Short-Acting β2 Agonists) 8 Hours prior testing
  • Atrovent or Combivent (Ipratropium bromide) 12 hours prior testing
  • Fluticasone, Symbicort (inhaled corticosteroids plus β2 Agonists) 24 hours prior testing
  • Salmeterol, formoterol (Long-Acting β2 Agonists), Theophyline, 24 hours prior testing
  • Spiriva, Respimat (Tiotropium Bromide), Antihistamines, 72 hours prior testing
  • montelukast (Leukotriene – Receptor Antagonists) 4 days prior testing


Some food interactions: Ingestion of significant quantities of coffee, tea, cola drinks, chocolate or other foods containing caffeine may decrease bronchial responsiveness and should be totally avoided on the day of the test.


Smoking and vigorous exercise should not be undertaken on the day of the test.


Test Procedure



You will be asked to sit comfortably on a chair. Initially you will be asked to blow forcefully into a tube (spirometry test). After breathing out fully, you will be asked to deeply breathe in the Mannitol medicine using a special inhaler and hold your breath for five seconds before breathing out. Next you will be asked to blow forcefully into the tube again. This test measures the effect of the Mannitol on your lungs. The previous steps described may be repeated up to 9 times with more and more Mannitol depending on the effect on your lungs, until the test is finished. Once the test has finished you will be given a medicine (Bronchodilator) to help you breathe.

Risks Involved



This test does not cause an asthma attack but the inhalation of the Mannitol for people who do have airway sensitivity their airways will become narrower and so they may find it harder to breathe. Also symptoms of cough, chest tightness, wheezing, chest soreness or headache can occur. Many subjects do not have symptoms at all. These symptoms (if they occur) are mild, last for only a few minutes, and disappear following the inhalation of a bronchodilator medication.

If you have any of the following please call us to discuss:

  • Unstable angina
  • A recent pneumothorax (air trapped beneath the chest wall)
  • A recent heart attack or stroke
  • Recent eye or abdominal surgery
  • Coughed up blood recently and the cause is not known
  • Known hypersensitivity to mannitol or gelatin used to make capsules
  • Conditions that may be compromised by induced bronchospasm or repeated spirometry maneuvers
  • High blood pressure
  • Pregnancy
  • Nursing mothers Patients 6-18 years of age, due to limited information on the use of Osmohale in this population.

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