This week's issue of the prestigious medical journal the Lancet is devoted to research findings on asthma. But the editorial accompanying the studies is what caught my eye.
In no uncertain terms, the authors of the editorial paint a dismal picture regarding a scientific understanding of the disorder and future treatment options. In essence, what they say is that we still don't know what asthma is, who gets it and why and which factors predict its severity and response to treatment. Indeed, the very term "asthma" is not helpful, they say.
"Two years ago we made a plea to abandon asthma as a disease concept. This plea is now more justified than ever. Asthma is at best a syndrome with different risk factors, different prognoses, and different responses to treatment. Without better understanding of the underlying differences, targeted treatment effort with improved outcomes will be incomplete and prevention will remain elusive."
The special issue includes several noteworthy studies, including research showing that rhinitis is a strong risk factor for future development of asthma. Moreover, a study from the Arizona Respiratory Center in Tucson found that more than 70% of people with current asthma at age 22 and 63% of young adults with newly diagnosed asthma had episodes of wheezing in the first three years of life or the symptoms were reported at age 6 by their parents. The study shows that asthma quite often has its roots in early childhood.
The studies add to a body of evidence that asthma involves a combination of genes and environmental factors. And control of the disease is elusive for many patients. Another paper in the Lancet shows that in one population of teenagers, many had difficulty controlling their symptoms. However, if correct guidelines for treatment were rigorously applied, asthma control improved greatly.
The current guidelines, however, are 440 pages long -- not exactly user-friendly. Simpler guidelines, cheaper medications and more time spent with the doctor would go a long way to improving asthma care, the Lancet editors note. But there is a long way to go before the majority of asthma suffers receive optimal care.
"Progress in understanding asthma and its underlying mechanisms is slow; treatment can be difficult and response unpredictable, and prevention or cure is still a pipe dream. Asthma, one of the most important chronic diseases, remains a genuine medical mystery."
For information on asthma, see the web page of the American Academy of Allergy, Asthma & Immunology.
-- Shari Roan
Photo credit: Lawrence K. Ho / Los Angeles Times