ATS Pulmonary Function Laboratory Manual

chapter  13

Test Procedure for Mannitol Challenge Test (7)

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Step Action 1.4.

Start the timer for 60 seconds at the end of inhalation and ask the patient to hold their breath for about 5 seconds after inhalation. 1.5. When 5 seconds has elapsed, instruct the patient to exhale through their mouth away from the inhaler, remove the nose clip, and to breathe normally. 1.6. At 60 seconds, perform spirometry on patient and obtain two FEV 1 values. The highest FEV 1 is retained as the Baseline FEV 1 . 1.7. If the highest FEV 1 is ≥ 10% lower than the pre-challenge FEV 1 , the test should be stopped. 2. Calculate the target FEV 1 2.1. Multiply Baseline FEV 1 by 0.85 and record this target value. 2.2. A positive challenge test is achieved when the patient’s FEV 1 falls ≥15% from their baseline FEV 1 . 3. Administer the 5 mg capsule 3.1. Insert the 5 mg capsule into the inhaler and pierce the capsule as in Step 1.2. 3.2. Repeat steps 1.3–1.5. 3.3. Following inhalation, remove the capsule from the inhaler and check to ensure it has been emptied sufficiently; if not, a second inhalation will be required immediately. 3.4. Load the 10-mg capsule to prepare for the next dose. 3.5. At 60 seconds following inhalation, perform spirometry on patient and obtain two FEV 1 values. Acceptability criteria must be met. Use the highest value to calculate the change in FEV 1 . Since FEV 1 is the only endpoint, a full FVC lasting at least 6 seconds or until a plateau is achieved may not need to be done. 3.6. Compare the FEV 1 value at this dose to the target FEV 1 . If the FEV 1 is equal to or below the target value, or there has been an incremental fall of at least 10% from the previous dose, the challenge is positive and complete. If not, immediately proceed to the next dose. 4. Administer the 10-mg capsule , following the directions given in Step 3. 5. Administer the 20-mg capsule , following the directions given in Step 3. 6. Administer the 40-mg capsule , following the directions given in Step 3. 7. Administer 80-mg dose (2 × 40-mg capsules). 7.1. Insert and pierce the first of the two 40-mg capsules that comprise the 80-mg dose. 7.2. The patient should inhale the dose in the same manner as previous doses, hold their breath for the 5 seconds, and then exhale. 7.3. Remove the first 40-mg capsule from the inhaler and check to ensure it has been emptied sufficiently; if not, a second inhalation will be required immediately. Do this check following the inhalation of the contents of each capsule. 7.4. Following inhalation, load the second 40-mg capsule and administer it immediately following the exhalation after the first 40-mg capsule.

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