Is overall asthma control being achieved? A hypothesis-generating study

The efficacy of asthma therapy is traditionally measured using single end-p oints. In contrast, the aim of therapy is to achieve overall control, defin ed by management guidelines as achieving a number of treatment goals. These goals reflect expert opinion, rather than being evidence based. The object ive of this study was to determine whether guideline-defined asthma control is achievable. Eight studies of salmeterol/fluticasone propionate combination therapy were analysed using three asthma control measures of varying stringency, derive d from the guideline goals, For each measure, only patients meeting all goa ls were classified as controlled. The analysis demonstrated that asthma control, as defined by management gui delines, can be achieved, For a given therapy, similar proportions of patie nts achieved control irrespective of disease severity, suggesting that outc ome expectations should not be reduced for patients with more severe diseas e. Substantially more patients achieved the target values for individual go als than achieved overall control, indicating that reliance on individual e nd-points is likely to result in significant overestimation of true control . The findings of this hypothesis-generating study should be prospectively te sted, Future research mill include a randomized controlled study designed t o assess the proportion of patients able to achieve overall control of asth ma when treatment is titrated appropriately.