Feasibility and acceptability of using bronchial hyperresponsiveness to manage asthma in primary care: a pilot study

Prim Care Respir J. 2012 Mar;21(1):28-34. doi: 10.4104/pcrj.2011.00079.


Aims: To determine if indirect testing for bronchial hyperresponsiveness (BHR) to monitor inhaled corticosteroid (ICS) treatment in asthma is feasible and acceptable in primary care.

Methods: Fourteen adult patients with asthma aged 22-70 years (4M:10F, forced expiratory volume in 1 s >70% predicted) taking ICS performed a test for BHR using mannitol on three visits 6 weeks apart. ICS dose adjustments were made based on the presence of BHR. The Asthma Quality of Life Questionnaire (AQLQ) and the Asthma Control Questionnaire were used at each visit. A semi structured interview at study exit assessed subject acceptability.

Results: BHR did not return in those with no BHR at study entry (n=9) with decreasing ICS dose. Improvements in BHR with increasing ICS dose (n=5) were observed with clinically significant improvements in AQLQ (mean score increase >0.5, p=0.02). Feasibility and acceptability of BHR testing was demonstrated.

Conclusions: It is feasible and acceptable to perform BHR testing using mannitol to help identify patients with asthma who would benefit from ICS dose increases and those with no BHR who could have a dose reduction.

Trial registration: Australia New Zealand Clinical Trial Registry ACTRN12610000807055.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adult
  • Aged
  • Anti-Inflammatory Agents / therapeutic use
  • Asthma / classification
  • Asthma / drug therapy*
  • Bronchial Hyperreactivity / drug therapy*
  • Bronchial Provocation Tests / methods*
  • Bronchoconstrictor Agents*
  • Feasibility Studies
  • Female
  • Forced Expiratory Volume / drug effects
  • Humans
  • Male
  • Mannitol*
  • Middle Aged
  • Pilot Projects
  • Primary Health Care / methods*
  • Treatment Outcome


  • Anti-Inflammatory Agents
  • Bronchoconstrictor Agents
  • Mannitol