The ADMIT series - issues in inhalation therapy. 1) The goals of asthma treatment: can they be achieved?

The widespread use of inhaled corticosteroids (ICS) since the early 1970's has meant that asthma is generally better controlled in comparison with previous decades. Nevertheless, recent patient interview surveys indicate that there is still a lot to gain in terms of abolishing daytime and nocturnal symptoms, and asthma exacerbations. It is important to use the terms asthma 'control' and asthma 'severity' in a correct way. Whereas asthma control reflects fluctuation in symptoms and lung function (or lack of them) over time, asthma severity reflects both asthma control and the need for medication. Thus, 'severity' is a property of the disease which reflects the degree of pathophysiological abnormality, whereas 'control' refers to the reduction of the clinical manifestations of disease achieved by treatment - thereby reflecting the adequacy of treatment. This introductory review, the first of a series of review papers to be published in this journal by the ADMIT team (see Appendix), discusses briefly our present knowledge of asthma control, its components, factors that may limit patients' ability to achieve optimal asthma control, and instruments to measure asthma control.