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Current challenges in asthma.

Population surveys indicate that the increase in the prevalence of asthma may now be flattening off. This coincides with increasing use of inhaled corticosteroids, given to two-thirds of asthmatics treated by their GPs by the late 1990s, which may explain the decrease in serious asthma attacks and mortality in the UK in the past decade.1 Nevertheless, many challenges remain in the diagnosis, prevention and treatment of asthma in primary care.

In theory, avoidance of triggers may prevent asthmatic symptoms and improve quality of life. However, persuading asthmatic patients to stop smoking, or to avoid favourite animals that trigger wheezing episodes, illustrates that the theory may not be so easy to translate into practice. Much evidence has emerged showing the benefit of self-management plans, and the paper by de Vries et al 2 seeks to answer the important question of the added value of mattress covers in patients already on management plans. They showed that the semi-permeable covers led to a significant reduction of the allergen levels in the mattress, but sadly this was not shown to translate into a significant reduction in the dose of inhaled steroids needed to maintain asthma control. Overall measures to avoid house dust mite have not been shown to make dramatic differences to the average patient with asthma3 (although, of course, there may be some who defy the average and …