Evidence map›Paper›PMID 34743708›Full record

ReviewRespiratory research2021

The use of the mannitol test as an outcome measure in asthma intervention studies: a review and practical recommendations.

Asger Sverrild, Joanna Leadbetter, Celeste Porsbjerg

Abstract readReview
In one paragraph

Review in Respiratory research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Asger SverrildDepartment of Respiratory Medicine, Bispebjerg Hospital, Copenhagen University, Ebba Lunds vej 48, 2400, Copenhagen, Denmark.
Joanna LeadbetterStatistics Manager, Pharmaxis, Frenchs Forest, NSW, Australia.
Celeste PorsbjergDepartment of Respiratory Medicine, Bispebjerg Hospital, Copenhagen University, Ebba Lunds vej 48, 2400, Copenhagen, Denmark. Celeste.Porsbjerg@regionh.dk.ORCID http://orcid.org/0000-0003-4825-9436

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe mannitol test is an indirect bronchial challenge test widely used in diagnosing asthma. Response to the mannitol test correlates with the level of eosinophilic and mast cell airway inflammation, and a positive mannitol test is highly predictive of a response to anti-inflammatory treatment with inhaled corticosteroids. The response to mannitol is a physiological biomarker that may, therefore, be used to assess the response to other anti-inflammatory treatments and may be of particular interest in early phase studies that require surrogate markers to predict a clinical response. The main objectives of this review were to assess the practical aspects of using mannitol as an endpoint in clinical trials and provide the clinical researcher and respiratory physician with recommendations when designing early clinical trials.

methodsThe aim of this review was to summarise previous uses of the mannitol test as an outcome measure in clinical intervention studies. The PubMed database was searched using a combination of MeSH and keywords. Eligible studies included intervention or repeatability studies using the standard mannitol test, at multiple timepoints, reporting the use of PD

resultsOf the 193 papers identified, 12 studies met the inclusion criteria and data from these are discussed in detail. Data on the mode of action, correlation with airway inflammation, its diagnostic properties, and repeatability have been summarised, and suggestions for the reporting of test results provided. Worked examples of power calculations for dimensioning study populations are presented for different types of study designs. Finally, interpretation and reporting of the change in the response to the mannitol test are discussed.

conclusionsThe mechanistic and practical features of the mannitol test make it a useful marker of disease, not only in clinical diagnoses, but also as an outcome measure in intervention trials. Measuring airway hyperresponsiveness to mannitol provides a novel and reproducible test for assessing efficacy in intervention trials, and importantly, utilises a test that links directly to underlying drivers of disease.

Indexed as

Practice Guidelines as TopicAdministration, InhalationAsthmaBronchial Provocation TestsDiuretics, OsmoticHumansMannitolDiuretics, OsmoticMannitolAirway hyperresponsivenessAsthmaBronchoprovocationIntervention studiesMannitolOutcome measurePD15

Identifiers

PMID34743708
PMCPMC8574016

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.