© 2003 BMJ Publishing Group & British Thoracic Society
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In this issue of Thorax Heaney and colleagues describe a detailed evaluation of patients with therapy resistant asthma (TRA). A cohort of asthma patients was systematically evaluated and a group identified with TRA. The objective was to identify factors that predicted the prognosis of patients with difficult asthma. Considerable co-morbidity such as oesophageal reflux and psychological problems were found in both groups of asthmatics, so TRA is not specifically related to co-morbidity. Factors predicting difficult asthma were a high dose of inhaled steroid at presentation, FEV1 below 70% predicted, and previous specialist assessment. As Harrison points out in the accompanying editorial, it is hoped that the approach used in this paper will encourage others to become interested in this difficult patient group, to set up special clinics, and evaluate new therapeutic strategies. See pages 555 and 561
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