Asthma: 1987-2007. What have we achieved and what are the persisting challenges?

Despite an increasing prevalence of asthma, enormous advances have been made in our understanding and management of asthma over the last 20 years. Work begun two or three decades ago demonstrated the inflammatory nature of asthma, emphasised the need for regular treatment, and introduced the goal of maintaining normal lung function. More recent work demonstrated the benefits of adding a long-acting inhaled beta-agonist to low-dose inhaled steroids as an alternative to escalating the steroid dosage. More recently still, studies and regulatory approval have led to the possibility of the same inhaler being used for maintenance therapy and for relief. However, these new ways of using old medicines, along with some new medicines such as omalizumab, should not detract us from looking beyond the prescription. The challenges facing us now are to determine why the prevalence of asthma has increased so dramatically, and in the absence of a cure how we can best help increasing numbers of people with asthma benefit from the treatment which is available. This will involve a much more aggressive implementation of advice regarding self-management education and a restructuring of health services to provide a service that is cognisant of the fact that, like us, patients are increasingly busy - and if they are to benefit from regular review, that review needs to be offered at a convenient time and by convenient methods.