title: Feasibility and acceptability of using bronchial  hyperresponsiveness to manage asthma in primary care:  a pilot study.
abstract: OBJECTIVE
  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.
  
  
  BACKGROUND
  Australia New Zealand Clinical Trial Registry ACTRN12610000807055.
authors.affiliation: Medical School, Australian National University, Canberra, ACT 2606, Australia. james.turton@anu.edu.au
authors.forename: James A
authors.initials: JA
authors.lastname: Turton
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Glasgow
authors.forename: John D
authors.initials: JD
authors.lastname: Brannan
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000145:classification / Q000188:drug therapy*; D016535:Bronchial Hyperreactivity / Q000188:drug therapy*; D001985:Bronchial Provocation Tests / Q000379:methods*; D016085:Bronchoconstrictor Agents; D005240:Feasibility Studies; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D008353:Mannitol; D008875:Middle Aged; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D016085:Bronchoconstrictor Agents; D008353:Mannitol