Bronchial asthma is a common chronic respiratory disease, a chronic inflammatory disease of the airways, and the current treatment philosophy is that asthma should be treated in the same way as other chronic diseases such as diabetes and hypertension, with long-term standardized medication control therapy, so as to prevent acute asthma attacks, reduce the occurrence of complications, improve lung function and enhance quality of life. 2006 Global Guidelines for the Prevention and Treatment of Asthma (GINA) The definition of clinical control of asthma includes the following 6 items: (1) no (or ≤2/week) daytime symptoms; (2) no limitation of daily activities (including exercise); (3) no nocturnal symptoms or awakening due to asthma; (4) no (or ≤2/week) need for relieving medication; (5) normal or near-normal lung function; (6) No acute exacerbations of asthma. The goals of successful asthma management are: (1) to achieve and maintain symptom control; (2) to maintain normal activity, including exercise capacity; (3) to maintain lung function levels as close to normal as possible; (4) to prevent acute exacerbations of asthma; (5) to avoid adverse effects due to asthma medication; and (6) to prevent death due to asthma. The results of the global multicenter GOLD study show that for most asthma patients (including mild, moderate, and severe), clinical control as defined by the guidelines can be achieved in nearly 80% of patients after one year of salmeterol/co-tikasone (sulforaphane) combination.The GOLD study results give great confidence to asthma specialists and asthma patients, and indicate the direction of treatment. Several domestic and international studies have also shown that most asthma patients can achieve good control if they follow the standard treatment and management recommended by GINA. So, how do you reach and maintain asthma control as defined by the guidelines? In 2006, GINA proposed that asthma treatment and management is a continuous cycle of clinical control, including assessment of the level of asthma control, treatment to achieve asthma control, and monitoring to maintain asthma control. It also proposed a new concept of graded treatment with asthma control level, which assesses asthma control level based on 6 composite indicators such as clinical symptoms and lung function, and is classified into 3 levels: controlled, partially controlled and uncontrolled . ACT distinguishes the level of asthma control by answering 5 questions on asthma symptoms and quality of life with a score of 25 as fully controlled, 20-24 as well controlled and less than 20 as uncontrolled. This method is not only suitable for clinical research, but also for assessing the level of asthma control in clinical work, and is especially suitable for promotion in primary care. As a supplement to pulmonary function testing, it is suitable for both physicians and patients’ self-assessment. Once the patient’s level of control has been determined, the level of treatment is determined according to the patient’s level of asthma control and the appropriate level of therapeutic medication is selected. 2006 GINA divided the levels of asthma treatment into 5 levels. The choice of control medication is based on inhaled glucocorticoids (ICS), to which the dose of inhaled ICS may be increased or other control medications may be added depending on the level of treatment. The choice of initial treatment: most patients with persistent, untreated asthma can be selected for level 2, or directly for level 3 if the initial symptoms suggest uncontrolled asthma. All patients should receive asthma education and environmental control, avoid allergen exposure, and use rapid-acting β2 agonists as needed for rapid symptom relief. According to several domestic and international studies, the combination of inhaled glucocorticoids (ICS) plus inhaled long-acting β2 agonists (LABA) is superior to other treatment options for asthma control and improvement of lung function. The combination device of salmeterol/coctaxone (sulforaphane, LABA/ICS) has three different options for the dose of ICS, 100ug, 250ug, and 500ug, for low, medium, and high doses, for different treatment levels and options for escalation and downgrading of treatment. the GOLD study used different doses of sulforaphane, based on the principle of escalation of treatment. The results of a one-year treatment of asthma patients showed that the combination therapy with salmeterol/co-tikasone (sulforaphane) was significantly better than ICS alone in terms of symptom control, improvement in lung function, and improvement in quality of life; the results of the study showed that close to 80% of asthma patients achieved asthma control as defined by the guidelines with appropriate doses of sulforaphane. For this reason, the Asthma Control Dosing (ACD) strategy was proposed based on the GOLD study results, which refers to the regular and continuous use of appropriate doses of sulforaphane to achieve and maintain asthma control as defined by the GINA guidelines, and the use of the ACT tool to assess and monitor asthma control levels. Depending on the level of asthma control, different doses of sulforaphane are used to escalate or downgrade therapy. This strategy makes asthma control and management simpler, more effective and feasible, and deserves clinical promotion. After asthma control is achieved, continuous monitoring is necessary to maintain asthma control and to establish the lowest level and minimum dose of therapy in order to minimize cost and ensure safety. When asthma symptoms worsen then treatment should be escalated. Asthma control and management should be a patient-doctor partnership with long-term, regular monitoring and follow-up. Patients with initial treatment or acute exacerbations should be followed up once every 2 weeks and once every 1 to 3 months when the disease has stabilized. Asthma control level assessment and ACT test should be given at each follow-up visit, and the treatment level should be adjusted promptly according to the control level. Most patients’ symptoms start to improve within a few days after the application of control medication, but it takes 3 to 4 months for the full effect to be realized. Patients with severe asthma or chronically under-treated asthma will take longer. When clinical control of asthma cannot be achieved with the original level of therapy, escalation of therapy should be considered. For the choice of escalation regimen, either from level 2 to level 3, or level 3 to level 4, and level 4 to level 5, the choice of therapeutic agents is based on the addition of one or more control medications, such as LABA, increased dose of ICS, leukotriene modulators, and slow-release theophylline, to the inhaled ICS. Based on current evidence-based medical findings and clinical experience, the following are recommended: if low-dose ICS is used, LABA can be added, such as the choice of sulforaphane, if low-dose sulforaphane is used for initial treatment, and medium-dose sulforaphane can be used for escalating treatment, if medium-dose sulforaphane is used for initial treatment, and high-dose sulforaphane can be used for escalating treatment. When complete control of asthma is achieved and maintained for 3 months, step-down therapy may be considered. For the choice of step-down regimen, for those who have achieved control with ICS + LABA: first reduce the ICS dosage by 50% and leave the LABA dosage unchanged. If control is still maintained for at least 3 months then further reduce the ICS dose, or ICS+LABA from twice daily, to once daily and continue to maintain treatment for 3 months, if control is still maintained, consider discontinuing LABA and maintaining treatment with the lowest dose of ICS for 1 year. Achieving and maintaining asthma control is a long-term therapeutic management process that must through standardized treatment by physicians, patient education, and the establishment of a physician-patient partnership to improve patient compliance and to jointly develop a self-management plan. Our asthma clinic has been following GINA and Chinese asthma control guidelines for many years, providing standardized treatment and management of asthma patients and regular patient education. More than 200 asthma patients have been registered and managed, and all of these patients have good compliance, can follow up regularly, use inhalation devices correctly, score ACT correctly, and have significantly fewer acute attacks than before management, and many of them do not need use or little use of relievers. Approximately 80% of the asthma patients we have managed have achieved complete control or good control based on ACT scores.