[Fixed combinations as a first line treatment for all degrees of severity in asthma?]

Beyond the mild intermittent asthma the present German Asthma Guideline, published in 1998 supports the use of ICS for all steps of asthma severity. However, LABA's have only been recommended as an add on treatment for step 3 (moderate persistent) and 4 (severe asthma). At that time, fixed combinations containing LABA and ICS were not on the market yet. The development of sales of the combination product in industrialized countries including Germany shows that they are probably prescribed for first line treatment and for all steps of asthma severity. The role of these recently developed excellent drugs could not yet be defined by principles of evidence based medicine, i. e. by randomized, double-blind controlled trials. A vignette case should demonstrate that in the daily care even grading severity of asthma regarding the prescription of the appropriate treatment can be difficult. Since the costs of the combination treatment are high, nowadays financial considerations increasingly determine medical decisions in the German Health Care System. The consequent debate of an expert protagonist and an expert opponent should take all these aspects into consideration and help primary care and specialist care physicians to prescribe this type of drugs for the "right" patient.