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Distribution of therapeutic response in asthma control

To the Editor: 

The paper by Baumgartner et al. 1 raises very important questions pertaining to the interpretation and usefulness of randomised clinical trials, the use of surrogates of little relevance to the patient and the comparison of results using group average values. However, these problems are not adequately addressed.

Whilst reference is given to the Global Initiative for Asthma guidelines to define asthma control, the focus of the study is on percentage of asthma control days defined on a subset of asthma control measures only. This definition carries two weaknesses. First, it ignores important parameters that define asthma control. Lung function, including level of bronchial obstruction and its variability, is an …