In this issue of Thorax Blais et al 1 report results from a population based register study which show that first regular treatment with inhaled corticosteroids initiated in the year following the recognition of asthma can reduce by up to 80% the risk of a hospital admission for asthma compared with regular treatment with theophylline. It is a dramatic result, albeit not so surprising. Regular use of inhaled steroids prevents exacerbations of asthma,2 fatal and near fatal episodes of asthma,3 and accelerated loss of lung function.4 From 1985 to 1993 anti-inflammatory treatment with inhaled steroids decreased the number of hospital days per year in Swedish children to less than a third.5 In a large community sample in eastern Massachusetts inhaled steroids halved the risk of admission to hospital in each severity group.6 The data strongly supported the early prescription of inhaled steroids. In contrast, overconfidence in β₂ agonists combined with suboptimal use of inhaled steroids increased the risk of admission to hospital fivefold in Belgium.7

Hospital admission for asthma is a marker of severe and uncontrolled disease and indicates an increased risk of a subsequent fatal attack.8 The cost of hospital admissions represents 25–50% of the total costs for asthma, depending on whether the calculations include only direct …