Asthma: 1987-2007. What have we achieved and what are the persisting challenges?

Abstract

SummaryDespite an increasing prevalence of asthma, enormous advances have been made in our understanding and management of asthma over the last 20 years. Work begun two or three decades ago demonstrated the inflammatory nature of asthma, emphasised the need for regular treatment, and introduced the goal of maintaining normal lung function. More recent work demonstrated the benefits of adding a long-acting inhaled beta-agonist to low-dose inhaled steroids as an alternative to escalating the steroid dosage. More recently still, studies and regulatory approval have led to the possibility of the same inhaler being used for maintenance therapy and for relief. However, these new ways of using old medicines, along with some new medicines such as omalizumab, should not detract us from looking beyond the prescription. The challenges facing us now are to determine why the prevalence of asthma has increased so dramatically, and in the absence of a cure how we can best help increasing numbers of people with asthma benefit from the treatment which is available. This will involve a much more aggressive implementation of advice regarding self-management education and a restructuring of health services to provide a service that is cognisant of the fact that, like us, patients are increasingly busy -and if they are to benefit from regular review, that review needs to be offered at a convenient time and by convenient methods.

Prevalence and severity of self-reported asthma in young adults, 1976–2004

“…Our study revealed a change over time in the impact of BMI on lung function, and, furthermore, may suggest that, in subjects with self-reported asthma, there is an interaction between BMI and asthma status not found in subjects not reporting symptoms of asthma. Apart from suboptimal asthma control due to compliance-related issues [21,22], it is, therefore, likely that the observed increase in severity of asthma, as judged by FEV1, may be due to an increasing trend towards being overweight and obese, not least among subjects with self-reported asthma. The present study, however, did not reveal major clues towards understanding the mechanisms underlying the changes over time in prevalence of self-reported asthma.…”

Asthma control—Practical suggestions for practicing doctors in family practice

“…The recently published National Health and Wellness Study 4 suggests that these older studies of asthma control may not reflect the present control outputs. In this study of 37 000 randomly chosen individuals (all adults), in response to the question 'Have you ever been diagnosed as having asthma by a physician?'…”

“…Martin Partridge found that 55% of doctors thought that their patients were well controlled, despite poor control of such patients being revealed in the Asthma Control Questionnaire. 4 The now famous Suissa Study 7 which demonstrated that use of inhaled corticosteroids (ICSs) regularly resulted in falling asthma mortality, upholds the principle that non-adherence significantly increases the risk of death from asthma. All of these methods have been discussed in detail in other reviews.…”

Budesonide/formoterol for maintenance and reliever therapy in the management of moderate to severe asthma

“…These include the need for more aggressive implementation of self-management education for patients and the need for the physician to discuss and alleviate patient concerns regarding medication safety (27,28). Partridge (29) and Roberts et al (30) highlighted the need for accurate diagnosis of patients with severe asthma and the development of a structured protocol-based approach to offset potential differences in treatment strategy between specialists with a particular interest in severe asthma and other respiratory physicians. In addition, the failure of patients to correctly use their prescribed medication is a significant challenge in asthma management (7,9).…”