"In an article published in the journal Archives of Disease in Childhood, two respiratory specialists claim that doctors are overdiagnosing asthma in children, with inhalers being prescribed needlessly.
According to Asthma UK, 1.1 mill"...
(mannitol) Inhalation Powder
Bronchial Challenge Test Kit
RISK OF SEVERE BRONCHOSPASM
Mannitol, the active ingredient in ARIDOL (mannitol inhalation powder) , acts as a bronchoconstrictor and may cause severe bronchospasm. Bronchial challenge testing with ARIDOL (mannitol inhalation powder) is for diagnostic purposes only. Bronchial challenge testing with ARIDOL (mannitol inhalation powder) should only be conducted by trained professionals under the supervision of a physician familiar with all aspects of the bronchial challenge test and the management of acute bronchospasm. Medications (such as short acting inhaled beta-agonist) and equipment to treat severe bronchospasm must be present in the testing area. If severe bronchospasm occurs it should be treated immediately by administration of a short acting inhaled beta-agonist. Because of the potential for severe bronchoconstriction, the bronchial challenge testing with ARIDOL (mannitol inhalation powder) should not be performed in any patient with clinically apparent asthma or very low baseline pulmonary function tests (e.g., FEV1 < 1-1.5 liters or < 70% of the predicted values) [see WARNINGS AND PRECAUTIONS].
D-mannitol (referred to throughout as mannitol), the active ingredient in ARIDOL (mannitol inhalation powder) is a hexahydric alcohol, that is a sugar alcohol, with the following chemical name (2R,3R,4R,5R)-hexane-1,2,3,4,5,6hexol and chemical structure:
Mannitol is a white or almost white crystalline powder of free-flowing granules with an empirical formula of C6H14O6 and molecular weight of 182.2. Mannitol is freely soluble in water, and very slightly soluble in alcohol. Mannitol shows polymorphism.
The ARIDOL (mannitol inhalation powder) bronchial challenge test kit contains one single patient use dry powder inhaler and 3 consecutively numbered foil blister packs containing a total of 19 capsules of mannitol for oral inhalation. All except the 0 mg printed hard gelatin capsules contain dry powder mannitol for oral inhalation. The accompanying dry powder inhaler is a plastic device used for inhaling the capsules. All doses are to be administered using the same device supplied with each kit without washing or sterilizing the device at anytime during the test.
To use the delivery system, a mannitol capsule is placed in the well of the inhaler, and the capsule is pierced by pressing and releasing the buttons on the side of the device. The mannitol dry powder is dispersed into the air stream when the patient inhales rapidly and deeply through the mouthpiece.
There are no inactive ingredients in the mannitol capsules supplied with the ARIDOL (mannitol inhalation powder) bronchial challenge test kit. The 0 mg capsule and the bodies of the 5, 10, 20 and 40 mg capsules are clear. The white caps (5 mg) contain titanium dioxide. The yellow caps (10 mg) contain titanium dioxide and yellow iron oxide. The pink caps (20 mg) and red caps (40 mg) contain titanium dioxide and red iron dioxide. The inhaler is a plastic device used for administering mannitol to the lungs. The amount of drug delivered to the lung will depend on patient factors, such as inspiratory flow rate and inspiratory time. Under standardized in vitro testing at a fixed flow rate of 60 L/min for 2 seconds, the delivered dose from the inhaler from each of the 5, 10, 20 and 40 mg capsules is approximately 3.4, 7.7, 16.5 and 34.1 mg, respectively. Peak inspiratory flow rates (PIFR) achievable through the inhaler were evaluated in healthy and asthmatic individuals ranging from 7 to 65 years of age and with % FEV1 of predicted ranging from 67% to 123%. PIFR achieved in the study was at least 70.8 L/min in all subjects assessed. The mean PIFR was 118.2 L/min and approximately ninety percent of each population studied generated a PIFR through the device exceeding 90 L/min.
Last reviewed on RxList: 10/29/2010
This monograph has been modified to include the generic and brand name in many instances.
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