Asthma

There were three main areas of focus in this year's BTS conference. Firstly, adherence to the international guidelines on asthma management1 which, although emphasising the importance of both lung function and symptoms in guiding clinical decisions, clearly remain open to modification by future developments. Mitra et al from Dundee presented their study on asthmatic children in an outpatient setting where serial lung function data remained unhelpful, whereas their symptom scores were far more reliable in planning alterations to treatment.2

Secondly, in deciding whether to initiate long term treatment with inhaled corticosteroids in asthmatic patients a further study emphasised the importance of first documenting airway eosinophilia.3 The results of this work from Leicester suggested that asthmatic patients who were non-atopic or who smoked were less likely to show a baseline eosinophilia or improve on inhaled corticosteroids, thereby extending the findings of a previous similar study.4 A sentinel paper linking themes from these two studies was presented by Ward et al 5 in the excellent airway remodelling symposium. Their demonstration that changes in airway inflammation, remodelling, and bronchial hyperresponsiveness (BHR) in asthmatic subjects following treatment with inhaled corticosteroids werenot temporally concordant was of prime importance. Improvements in lung function and inflammation seen after treatment with inhaled corticosteroids were seenbefore any changes in airway remodelling or BHR. This continues …