RT Journal Article
SR Electronic
T1 The potential role of bronchial challenge testing to identify overtreatment of community managed asthma
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1693
VO 44
IS Suppl 58
A1 Arvind Manoharan
A1 Brian Lipworth
A1 Elizabeth Craig
A1 Cathy Jackson
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/1693.abstract
AB Introduction: Bronchial hyperresponsiveness is a defining feature of asthma and is measured by bronchial challenges which are not routinely used in primary care.Aim: To evaluate the potential role of direct (methacholine) and indirect (mannitol) challenge testing in primary care.Methods: Community managed asthmatics were identified by the Health Informatics Centre (HIC) and invited to take part in the study. At screening the following tests were carried out: spirometry, methacholine and mannitol challenge; FeNO, Asthma Control Questionnaire (ACQ-6) and Asthma Quality of Life Questionnaire (MiniAQLQ).Results: 3388 asthmatics were identified by HIC with 423 positive responses and 123 completing the study. 70% had either a positive methacholine (PC20<8mg/ml) or mannitol challenge (PD15<635mg) and 30% were non-responsive to both challenges. 14% of methacholine responders were negative to mannitol and 16% of mannitol responders were negative to methacholine. Spirometry, FeNO, ACQ and AQLQ were significantly better in the non-responder group who were exposed to high ICS dose and frequent LABA.View this table:Patient characteristics according to bronchial challenge responseConclusions: We found that 30% of patients with community managed asthma were challenge negative and also appeared to be overtreated, in turn suggesting the need for supervised step-down.