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Optimising Asthma Care

The dawn of the new millennium held much promise for medicine especially for chronic disorders such as hypertension, diabetes mellitus and asthma. Major clinical trials had been published, new therapies developed and the unraveling of pathogenetic mechanisms had opened our minds to a molecular network tantamount to a medical revolution. The next quantum leap that doctors had to make was to embrace this knowledge and transform medical practice: instead of having patients managed sub-optimally such that they remained diseased but rather to optimise treatment to render them “normal” - through near complete cessation of the pathological processes such that patients are completely asymptomatic and occult target organ damage nullified. This quantum step was not taken. Why? The chronic disorders mentioned above have one thing in common- they’re largely invisible. When, you observe a patient, you can’t “see” these diseases. Because of this, they’re treated inadequately and patients remain symptomatic with impairment of lifestyle and on-going disease progression. This is certainly true of asthma. Recent major surveys have revealed that the vast majority of asthmatics are uncontrolled. This is manifest by regular symptoms, impaired quality of life and absence from work or school. Health services continued to record high frequencies of emergency room visits, unscheduled doctor visits and hospitalization for acute severe asthma. With many chronic conditions, there is the recommendation that we treat to target; e.g. blood pressure or HbA1c for diabetes. With asthma, there appeared to be no definite targets and both patient and doctor accepted that asthma would elicit symptoms and limitations. This realisation prompted both the Global Initiative for Asthma (GINA) and the SA Thoracic Society (SATS) to commission updated guidelines the latter in this issue. 1