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Clinical Trial
. 2012 Mar;21(1):28-34.
doi: 10.4104/pcrj.2011.00079.

Feasibility and Acceptability of Using Bronchial Hyperresponsiveness to Manage Asthma in Primary Care: A Pilot Study

Free PMC article
Clinical Trial

Feasibility and Acceptability of Using Bronchial Hyperresponsiveness to Manage Asthma in Primary Care: A Pilot Study

James A Turton et al. Prim Care Respir J. .
Free PMC article


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.

Conflict of interest statement

JAT holds shares in Pharmaxis Ltd. NJG has no conflict of interest. JDB receives royalties from the sale of Aridol™/Osmohale™, holds shares in Pharmaxis Ltd, and has acted as a consultant to Pharmaxis Ltd.


Figure 1
Figure 1. Individual data for bronchial hyperresponsiveness (BHR) to mannitol (provoking dose of mannitol to cause a 15% fall in forced expiratory volume in 1 s (FEV1), PD15), lung function (FEV1 % predicted), Asthma Quality of Life Questionnaire (AQLQ) overall score and Asthma Control Questionnaire (ACQ) score. The baseline negative BHR group (no BHR, n=9) had an inhaled corticosteroid (ICS) dose reduction over 12 weeks. The baseline positive BHR group (BHR, n=5) had an ICS dose increase over 12 weeks. Grey circles represent no BHR. *p<0.05.
Figure 2
Figure 2. Mean and standard error of the doses of inhaled corticosteroid (fluticasone equivalents = μg) and long-acting β2-agonist (pooled doses = μg) at each study visit over 12 weeks for subjects without bronchial hyperresponsiveness (BHR) to mannitol (n=9) and those with BHR (n=5) at the beginning of the study. *p<0.05, **p<0.01, ***p<0.001.

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