VIEWS & REVIEWS

Asthma management is redefmed Despite growing awareness, bronchial asthma is

grossly underdiagnosed and undertreated. Considerable differences in the diagnosis and management of this condition have been noted both within, and between, different countries. The International Asthma Management Project has published the 'International Consensus Report on Diagnosis and Management of Asthma' in the European Respiratory Journal.

This report provides a basis for a better questioning and redefinition of the goals of asthma therapy. The reversal or prevention of airway narrowing has gradually been replaced by the achievement and maintenance of asthma control. These goals should improve quality of life and prevent progression of irreversible airway obstruction.

Asthma severity has also been reassessed and graded. Emphasis on the objective evaluation of airflow by peak expiratory flow rate monitoring has been increased.

In addition, a systematic stepwise drug regimen has been proposed. Earlier proposals have been amended and refined. 'The project group has succeeded in providing a well-balanced ~'iew of present-day asthma management . . , '

The new recommendations include: • The earlier introduction of inhaled corticosteroids • The 'as required' (pm), instead of continuous, use

of beta agonists • A reduced role for theophylline. It is now an

'accessory' or 'other' bronchodilator. Detailed action or self-management plans,

including education of adults or children with asthma, have also been written and tested.

A number of critical questions still remain to be answered and directions for further research into better management have been defined. P Vermeire, from the Department of Respiratory Medicine, University of Antwerp, Belgium concluded that ' ... there is no doubt that this elegant document deserves to be widely disseminated and adhered to, before it will need to be updated again', Venne ire P. Growing consensus in asthma" European Respiratory Journal

5: 509·511. May 1992 ''''''''''''

ISSN 0156·0407/92/0222·003/$1 .oo© Adls International Ltd

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INPHARMA' 4 Ju11992