How far do we have to go to control asthma?

  Three basic conditions are needed to achieve the goal of “asthma control”.  First, health care professionals need to raise awareness and confidence that asthma is clinically curable to guide clinical practice. Evidence from large international multicenter clinical trials represented by GOAL tells us that 80% of mild and 60% of severe asthma patients can achieve “asthma control” after a period of treatment. In clinical practice, physicians can choose the feasible methods to assess the level of control of each asthma patient and guide the treatment according to their conditions.  Secondly, the misconception that “Western medicine does not treat asthma” should be corrected and patients’ expectations of asthma treatment should be raised.  Third, the health insurance system should cover effective treatment to ensure that patients can receive effective treatment in the long term. In the early 1980s, Finland had one of the highest asthma mortality rates in the world. The country aggressively adapted its health care strategy for asthma treatment to cover the effective medications (inhaled glucocorticoids) and asthma education available at the time. Over the next 20 years, asthma hospital days fell by 90% and mortality by 80%. The Finnish experience is worth learning from.  What is the best treatment to achieve “asthma control”?  Doctors need to consider several aspects. First, the choice of medication. For a significant number of patients with asthma, inhaled glucocorticoids (ICS) alone can achieve “asthma control,” and the combination of inhaled glucocorticoids and long-acting bronchodilators (ICS + LABA) can achieve “asthma control” in many more patients. The combination of inhaled glucocorticosteroids and long-acting bronchodilators (ICS + LABA) enables more patients to achieve “asthma control. Second, the appropriate dose of medication should be chosen according to the severity of the disease, so that patients can achieve symptom control within a month if possible.  Once symptoms are under control, how is treatment maintained? How long does maintenance therapy take?  Adult asthma is a chronic disease with high recurrence, and acute exacerbations can easily be triggered by a variety of factors such as exercise, exposure to allergens, and colds. The late Australian scholar Woolcock pointed out in 2001 that the length of time it takes to achieve control varies between asthma manifestations, and that airway hyperresponsiveness, which is the essence of asthma disease, requires several years of treatment to control. Regular medication and long-term maintenance therapy after asthma symptom control is of great importance to prevent recurrence and reduce asthma mortality. In mild asthma with seasonal intermittent attacks, if only one attack occurs per year, the choice of starting medication and dose is determined by the severity of the attack and maintenance therapy should be no less than 2 months.