Asthma--the problem and the paradox.

Abstract

Asthma is a common condition world-wide. Recent data show an increase in prevalence in the United Kingdom, and there is disturbing evidence of increases in morbidity and mortality from asthma in many countries. The reasons for these increases are unclear, but they are occurring in the face of dramatic increases in the sales of potent anti-asthmatic medications, with a particular emphasis on the use of beta agonists and inhaled corticosteroids. Furthermore, despite much publicity and education, the management of acute severe asthma is variable and often ineffectual. Identification of the reasons for the epidemiological trends is essential. The development of new potent prophylactic agents for treatment will help; it is, however, incumbent on us to examine our current pharmacological approach to asthma and to re-evaluate the drugs currently available, both in terms of their clinical use and our understanding of their modes of action. Comparison of morbidity and mortality figures between countries, and relating these figures to what is known about the use of medication in those countries should help clarify and co-ordinate approaches to treatment, and dispel some of the therapeutic myths which have currency at present.