Open Access Research article

An open-label study examining the effect of pharmacological treatment on mannitol- and exercise-induced airway hyperresponsiveness in asthmatic children and adolescents with exercise-induced bronchoconstriction

Salome Schafroth Török1, Thomas Mueller1, David Miedinger1, Anja Jochmann12, Ladina Joos Zellweger1, Sabine Sauter3, Alexandra Goll3, Prashant N Chhajed1, Anne B Taegtmeyer4, Bruno Knöpfli3 and Jörg D Leuppi56*

Author Affiliations

1 Internal Medicine, University Hospital Basel and University of Basel, Basel, Switzerland

2 University Childrens Hospital Basel, Basel, Switzerland

3 Alpine Childrens Hospital Davos, Davos, Switzerland

4 Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland

5 Internal Medicine, Kantonal Hospital Baselland and University of Basel, Basel, Switzerland

6 University Clinic of Internal Medicine, Kantonsspital Baselland, Liestal, Switzerland

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BMC Pediatrics 2014, 14:196  doi:10.1186/1471-2431-14-196

Published: 2 August 2014



Mannitol- and exercise bronchial provocation tests are both used to diagnose exercise-induced bronchoconstriction. The study aim was to compare the short-term treatment response to budesonide and montelukast on airway hyperresponsiveness to mannitol challenge test and to exercise challenge test in children and adolescents with exercise-induced bronchoconstriction.


Patients were recruited from a paediatric asthma rehabilitation clinic located in the Swiss Alps. Individuals with exercise-induced bronchoconstriction and a positive result in the exercise challenge test underwent mannitol challenge test on day 0. All subjects then received a treatment with 400 μg budesonide and bronchodilators as needed for 7 days, after which exercise- and mannitol-challenge tests were repeated (day 7). Montelukast was then added to the previous treatment and both tests were repeated again after 7 days (day 14).


Of 26 children and adolescents with exercise-induced bronchoconstriction, 14 had a positive exercise challenge test at baseline and were included in the intervention study. Seven of 14 (50%) also had a positive mannitol challenge test. There was a strong correlation between airway responsiveness to exercise and to mannitol at baseline (r = 0.560, p = 0.037). Treatment with budesonide and montelukast decreased airway hyperresponsiveness to exercise challenge test and to a lesser degree to mannitol challenge test. The fall in forced expiratory volume in one second during exercise challenge test was 21.7% on day 0 compared to 6.7% on day 14 (p = 0.001) and the mannitol challenge test dose response ratio was 0.036%/mg on day 0 compared to 0.013%/mg on day 14 (p = 0.067).


Short-term treatment with an inhaled corticosteroid and an additional leukotriene receptor antagonist in children and adolescents with exercise-induced bronchoconstriction decreases airway hyperresponsiveness to exercise and to mannitol.

Exercise-induced bronchoconstriction; Airway hyperresponsiveness; Children; Exercise challenge test; Mannitol challenge test