Relationship between changes in quality of life and measures of lung function and bronchial hyper-responsiveness during high-dose inhaled corticosteroid treatment in uncontrolled asthma

Objective: To examine the relationship between changes in quality of life and measures of lung function and bronchial hyper-responsiveness (BHR) during treatment with high-dose inhaled corticosteroids in patients with uncontrolled asthma. Methods: Thirty patients with uncontrolled asthma currently receiving inhaled corticosteroids (median dose 550 µg/day) were treated with beclomethasone dipropionate (BDP) dry powder 2000 µg/day for 4 weeks. Patients completed the Asthma Quality of Life Questionnaire (AQLQ), underwent bronchial challenge with methacholine and spirometry, and made entries in asthma diary cards at baseline and after treatment with beclomethasone dipropionate. Results: The mean change in overall AQLQ score improved significantly (p < 0.05) during the 4-week period by 0.57 (95% CI 0.29–0.84, p < 0.05), representing a minimal important difference, with similar improvements in individual domains. Change in overall AQLQ score correlated significantly with FEV1 (p < 0.001), forced mid-expiratory flow between 25–75% of vital capacity (FEF25–75) [p < 0.05] and morning PEF (p < 0.05), but not with methacholine PD20 i.e. the provocative dose of methacholine causing a 20% fall in FEV1. Conclusions: Quality-of-life scores related to changes in lung function but not BHR during short-term high-dose inhaled corticosteroid therapy for uncontrolled asthma.