Approaches to asthma management. Realities and recommendations.

As asthma prevalence continues to increase, so does its impact on public health and on health care systems. Despite the prescription of more antiasthma medications than ever before, morbidity and mortality associated with asthma continue to increase. The focus of asthma therapy is changing, with a greater emphasis on control of the inflammatory rather than the bronchoconstrictive component. Several sets of guidelines recently developed by groups of asthma specialists clearly reflect this new focus. While such recommendations are intended to help physicians more accurately diagnose asthma by severity and better manage its symptoms, uniformity in both areas is lacking. Disparities are seen not only among physicians overall but also among primary care physicians compared with subspecialists. New survey data help to illustrate how reality--the clinical approaches of these physician subgroups--differs from current recommendations. Physicians who treat patients with asthma may find that their approaches are in agreement with those of their peers. Nonetheless, they may also find that they deviate from guidelines that could improve clinical outcome for a substantial number of patients with asthma.