Clinical Review

Recent developments in asthma management

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7491.585 (Published 10 March 2005) Cite this as: BMJ 2005;330:585
  1. Graeme P Currie, specialist registrar in respiratory medicine (graeme.currie@nhs.net)1,
  2. Graham S Devereux, consultant in respiratory medicine1,
  3. Daniel K C Lee, specialist registrar in respiratory medicine3,
  4. Jon G Ayres, professor of occupational and environmental medicine2
  1. 1 Chest Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN
  2. 2 Department of Environmental and Occupational Medicine, Aberdeen AB25 2ZP
  3. 3 Department of Respiratory Medicine, Ipswich Hospital, Ipswich IP4 5PD
  1. Correspondence to: G P Currie
  • Accepted 18 January 2005

Introduction

Asthma is a common chronic heterogeneous condition with several characteristic features (%fig 1). It can present in early childhood as well as in adulthood, and it varies markedly in severity, clinical course, subsequent disability, and response to treatment. In common with other atopic disorders such as allergic rhinitis, atopic dermatitis, and food allergy, the prevalence of asthma has risen over the past few decades in both developed and developing countries.1 The increasing burden of asthma in primary and secondary care has led to extensive research into its genetics, pathophysiology, and treatment. In this review, we highlight some of the recent developments in the clinical management of asthma and identify key areas in which further research is needed.

Fig 1

The key components of asthma

Methods

We did a comprehensive literature search using Medline, Clinical Evidence, the Cochrane Library, and Embase. We used the following keywords in the search: acute asthma, chronic asthma, leucotriene receptor antagonist, long acting β2 agonist, inhaled corticosteroid, action plans, allergen, diet, magnesium, vitamin, Buteyko, anti-immunoglobulin E, and interleukin. We selected and extracted recent articles from 2000 onwards that we felt to be of relevance or interest to practising clinicians, as well as choosing topics that we were aware of being potentially important. All the authors are respiratory physicians with an interest in airways disease.

Chronic asthma

Non-pharmacological management

Allergen avoidance

Atopy and asthma are separate conditions with differing genetic and epidemiological associations. Although atopic sensitisation increases the likelihood of asthma, this is not an absolute association. Allergen avoidance is commonly recommended in patients with asthma, especially those who show type 1 hypersensitivity to common aeroallergens.1 2 However, a surprising lack of evidence based data exists to substantiate the effectiveness of this approach. Several major studies have specifically evaluated allergen avoidance and its impact on asthma control. In a double blind randomised placebo …

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