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The paper by Ward et al1 confirms the findings of Laitinen et al2 showing that airways inflammation is present even in patients with mild asthma. This emphasises the importance of using anti-inflammatory drugs (steroids) as soon as the diagnosis of asthma has been confirmed, even in patients thought to have only “mild asthma”. Without anti-inflammatory treatment, symptoms resulting from bronchial hyperresponsiveness are never controlled and optimal lung function is never attained. Over time, structural changes (remodelling) occur leading to a progressive decline in lung function3 and the risk of fixed obstruction (chronic obstructive pulmonary disease).
The present widespread dependence on bronchodilators in the UK may contribute to the fact that we have one of the highest respiratory death rates in Europe.4 The use of bronchodilators alone as in step 1 of the BTS guidelines should be discouraged, and treatment started at step 2 with regular inhaled corticosteroids to control symptoms and maximise peak flow rate. Bronchodilators should be used only as necessary for breakthrough wheezing. These principles have been used …
Footnotes
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Chris Ward is a European Respiratory Society long term research fellow. The work was also supported by Australian NHMRC and a grant in aid from Glaxo Smith Kline.