From around the world we have had evidence that the “guideline-driven” attainment of good asthma control is not being achieved.1 2 3 Surveys over the past decade have provided the evidence and concluded that “physicians and patients should raise their expectations of the level of asthma control that can be achieved”,2 and “the critical need for improved asthma care, including a more global evaluation of asthma control, implementation of asthma treatment plans and addressing co-morbid conditions”.3 In this issue of Thorax the article by Kandane-Rathnayake et al4 describes the loss of lung function in middle-aged patients not using inhaled corticosteroids for their asthma (see page 1025). This study adds to the survey evidence1 2 3 by providing lung function data in a population that has been part of an asthma cohort study for several decades. It is a timely wake-up call that, in spite of having doctor-agreed guidelines for asthma management available for two decades,5 predominantly in …