Asthma is common, results in extensive morbidity and occasional mortality,
and is associated with highly variable outcome. A major factor influencing
outcome relates to physician decision making. Subspecialty directed asthma
management has been demonstrated to favorably influence outcome of asthma t
o a greater extent than any other variable in care. National guidelines app
ear to have had little impact on primary care of asthma despite their wides
pread distribution. As a substitute for those extremely comprehensive and e
xtensive guidelines, a small number of measures can be identified that are
both realistically applicable in the primary care setting while having the
greatest impact on outcome. These low intensity high yield measures, if app
lied, can substantially reduce emergency care requirements and hospitalizat
ions. Patients not responding adequately to those measures should he identi
fied early and referred to subspecialists for subsequent ongoing management
.