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Response to mannitol in asymptomatic subjects with airway hyper‐responsiveness to methacholine

Background Bronchial provocation using methacholine, a cholinergic agonist, causes airway narrowing directly by contraction of bronchial smooth muscle. While methacholine has a high sensitivity for identifying airway hyper‐responsiveness (AHR), it does not have a high specificity to diagnose asthma and false‐positive responses may be observed in non‐asthmatics. Mannitol is an osmotic stimulus that acts indirectly to cause airway narrowing by release of endogenous bronchoconstricting mediators.