Is there a best outcome measurement for patients with asthma?

To summarize the outcomes used to evaluate inhaled corticosteroid intervention in terms of the Economic, Clinical, and Humanistic Outcomes (ECHO) model and to discuss the value of this more comprehensive approach in assessing therapeutic efficacy in asthma.

Relevant articles were identified by a search of the PubMed database for English-language articles published from 1991 to 2006 and references identified from bibliographies of relevant articles.

The author's expert opinion was used to select studies for inclusion in this review.

Studies that assessed therapeutic effectiveness of inhaled corticosteroids in patients with asthma have traditionally focused on clinical indicators of treatment effect, including pulmonary function and symptoms. However, reliance on clinical indicators alone may not represent the full effect of the treatment on patients with asthma. The ECHO model is proposed as a more comprehensive and useful alternative to evaluate therapeutic effectiveness in patients with asthma. The model takes into account more recent concerns of patients and health care practitioners, including quality of life and treatment cost. Clinical studies using various ECHO outcomes are presented and the limitations of using individual outcomes are discussed. The Pediatric Asthma Episodes of Care Program, which exemplifies successful application of the ECHO model in the real-world setting, is also discussed.

The more comprehensive approach to determining therapeutic effectiveness in asthma provided by the ECHO model should enable optimization of asthma treatment, with limited health care resources.