Diagnosis and management of adult asthma

Asthma is a disorder of the airways that is characterized by typical symptoms arising from a complex interplay between chronic inflammation and disordered airway function. Worldwide disease prevalence continues to rise steadily and the condition contributes to significant morbidity and preventable mortality. The goals of treatment in asthma are to achieve control of symptoms and to prevent exacerbations. Important non-pharmacological measures include patient education, avoidance of triggers and smoking cessation. Pharmacological management involves the stepwise titration of β-agonist bronchodilators and inhaled corticosteroids according to symptoms. Although satisfactory control of asthma is achieved in primary care for a large proportion of patients, between 5 and 10%, with so-called ‘refractory asthma’, remain poorly controlled and contribute disproportionately to asthma-related morbidity and mortality. The reasons for this are complex and multifactorial and many patients with refractory asthma require referral to specialist centres.