Using clinical measures of disease control to reduce the burden of asthma.

Clinical treatment guidelines encourage physicians to select asthma treatment in order to achieve established clinical treatment goals. Treatment selected on this basis may have profound effects upon other outcomes, some of which, such as improvements in well-being and lifestyle, are of direct benefit to the patient, and others, such as utilisation of healthcare resources and productivity, are of benefit to society. There is, however, evidence that a large proportion of patients do not achieve the goals of asthma management, such as those appearing in the international guide produced by the Global Initiative on Asthma (GINA). Furthermore, evaluation of the individual guideline goals provides little indication of the level of overall control achieved in individual patients, in spite of the fact that overall or comprehensive control is likely to be of greater value to the patient than control of only limited aspects of the disease. To give an indication of overall asthma control, and assess whether it is possible to reach this target, the GINA goals of asthma management have been amalgamated into a composite measure of overall asthma control. This approach has been used to assess recent clinical trials with the fluticasone propionate plus salmeterol combination given through a single inhaler compared with alternative treatment approaches. The studies showed that overall asthma control can be achieved, but at the fixed treatment doses used in clinical trials by only about half of the patients. Once such measures of control are included in management guidelines, healthcare professionals may need help to ensure implementation, using methods such as educational programmes and computerised disease management programmes. Improving asthma control in this way is likely to be associated with significant economic benefits.