Monitoring asthma severity and response to treatment

Guidelines for the management of asthma rely on various methods of assessing severity and how it changes in order to select the appropriate treatment. These methods have been developed from the basic clinical skills of history taking and physical examination to which attempts at improving objectivity have been added, such as the use of asthma diaries, the home recording of peak expiratory flow (PEF) or measurements of bronchial reactivity. The present review was an attempt to determine to what extent monitoring asthma by various techniques is justified. Unfortunately, diaries and home recording of PEF are easily faked and generally unreliable while objective tests, such as the measurement of bronchial reactivity or studies of induced sputum cannot be undertaken often enough for monitoring, and there is certainly the need for prospective longitudinal controlled studies.