EDITORIALS
Antagonism of tumour necrosis factor 
in refractory asthma
1 University of Birmingham, Edgbaston, Birmingham, UK
2 Institute for Lung Health, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
Correspondence to:
Dr Mike A Berry, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; m.a.berry@bham.ac.uk
| The first 150 words of the full text of this article appear below. |
Asthma that is refractory to treatment with inhaled corticosteroids affects 5–10% of patients with asthma; it is an important health and economic problem in the UK and most industrialised nations. It is estimated that 
17.7 billion is spent on asthma healthcare per annum in Europe,1 of which a disproportionately large amount is attributed to patients with refractory asthma, on average six times more per patient compared with mild to moderate disease.2 Patients with this condition suffer considerable morbidity and mortality and they therefore represent an important unmet clinical need. The European Respiratory Society2 and the American Thoracic Society3 have identified research into the mechanisms and treatment of refractory asthma as a research priority.
Asthma can be apparently refractory to treatment because of poor treatment adherence or because symptoms are caused by comorbid conditions such as rhinitis, hyperventilation and bronchiectasis.4 However, a significant number of patients have genuinely severe disease. The
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