Mannitol as an indirect bronchoprovocation test for the 21st century.

Objectives: To review mannitol challenge data and advocate the approval of this testing modality in the United States.

Data Sources: A literature review was performed using the MEDLINE database for English-language articles published between January 1, 1993, and July 31, 2009, using the following keywords: mannitol bronchoprovocation test, inhaled mannitol, inhaled mannitol and asthma, and inhaled mannitol and exercise-induced asthma.

Study Selection: Trials were selected that established the effect of mannitol as a bronchoprovocation challenge, explored mannitol's mechanism of action, and compared mannitol to other accepted bronchoprovocation challenges.