Mannitol Bronchial Provocation

The bronchial provocation test evaluates how sensitive the airways in your lungs are. A spirometry breathing test is done before and after you inhale a powder. For this test you will inhale increasing doses of a powder called mannitol.

Spirometry can show how much air you can breathe in and out. It also shows how fast you can breathe in and out. The spirometry results are compared before and after you inhale increasing doses of the powder to see what changes there are in your breathing.

A larygoscopy may be scheduled after the bronchial provocation test.  A larygoscopy is often done to identify if your vocal cords may be causing you to have trouble breathing. 


Preparing for the Test

Please follow these directions when getting ready for this test. These medicines will affect the results of some of these tests and need to be stopped before the testing is done.

If the medicine is not stopped before the test, we may not be able to complete the test. Please let your doctor know if you are not able to stop the medicine due to increased symptoms.

Stop this medicine for 4 days before your appointment:

  • Singulair® (montelukast)
  • Accolate® (zafirlukast)
  • Zyflo® (zileuton)

Stop these inhaled and oral medicines for 72 hours (3 days) before your appointment:

  • Spiriva® (tiotropium)
Antihistamines: Over the counter and prescription
  • Dimetapp® (bromphenamine)
  • Benadryl® (diphenhydramine)
  • Claritin® (loratadine)
  • Zyrtec® (cetirizine)
  • Allegra® (fexofenadine)
  • Xyzal® (levocetirizine dihydrochloride)

Stop this inhaled medicine for 48 hours before your appointment:

  • Arcapta® ((indacaterol)

Stop these inhaled medicines for 24 hours (1 day) before your appointment:

  • Advair® (Serevent® and Flovent®)
  • Symbicort® (Pulmicort® and Foradil®)
  • Dulera® (Azmanex® and Foradil®)
  • Serevent® (salmeterol)
  • Foradil® (formoterol)
  • Perforomist® (formoterol)
  • Brovana® (arformoterol)

Stop this oral medicine for 24 hours before your appointment:

  • Theophylline medicine

Stop these inhaled medicines for 12 hours before your appointment:

  • QVAR® (beclomethasone)
  • Pulmicort® (budesonide)
  • Flovent® (fluticasone)
  • Asmanex® (mometasone)
  • Alvesco® (ciclesonide)
  • Atrovent® (ipratropium)
  • Combivent® (albuterol and ipatropium)
  • DuoNeb® (albuterol and ipatropium)

Stop these inhaled medicines for 8 hours before your appointment:

  • Proventil HFA®
  • Ventolin HFA®
  • ProAir® (albuterol)
  • Xopenex® (levalbuterol)
  • Maxair® (pirbuterol),
  • Alupent®, Metaprel® (metaproterenol)
  • Primatene® Mist (terbutaline)
  • Intal® (cromolyn)
  • Tilade® (nedocromil)

Continue to take all of your other medicine as you usually do.

Pregnant women or mothers who are currently breast feeding may not perform a mannitol challenge test. Please advise your ordering doctor.

Adults - If a laryngoscopy is scheduled at the same time, do not eat for 2 hours before the test is scheduled.

Children - If a laryngoscopy is scheduled at the same time, do not eat for 3 hours before the test is scheduled.


Day of the Test

  • Avoid caffeine products the day of the test. These include: coffee, tea, soda, chocolate products
  • Avoid strenuous exercise.
  • Avoid smoking at least 6 hours before the test.


During the Test

You will do a number of spirometry breathing tests. You will be asked to inhale increasing doses of a powder between the breathing tests. The technician will explain what you need to do during each test. A good effort during the testing is important to get good results. The technician will coach you during each test to help you give a good effort. If you have questions during the tests, please ask the technician.


Length of the Test

Bronchial provocation testing often takes 1 hour.


Getting to Your Test

On the day of your scheduled test, report to room A310a in Pulmonary Physiology Services (PPS), located on the 3rd floor of the May building. If you have questions, please call Pulmonary Physiology Services at 303.398.1530.


This information has been reviewed by Joyce Cantebury, RPFT, MEd, MHA and Amy L. Olson, MD, MSPH (August 2012).