{"text":"2 - \n10338654X \nnon smoker. She also underwent a Mannitol Challenge, which showed moderately increased \u2018bronchial \nhyper-reactivity. . ' \nIn view of the diurnal variationin Mrs Clellands symptoms and their relationship with exercise and positive \nMannitol Challenge, I feel it is likely that Mrs Clelland has either asthma or post infective bron chial hyper- \nreactivity. I would therefore be grateful if you would consider starting her on Symbicort 20076, two \npuffs b.d. to see if this helps to confrol her symptoms. I would be grateful if she could remain on this \ndose for at least four to six months. If her symptoms are well under control at this point, it would be \nworth stepping down her asthma therapy in order to maintain her on the lowest possible dose of inhaled \ntherapy. I have not arranged to see her.back at clinic, but would be happy to do so should further \nproblems arise. \u2019 \nYours sincerely \nKarine Clearie . 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