Using clinical measures of disease control to reduce the burden of asthma

Clinical treatment guidelines encourage physicians to select asthma treatme nt in order to achieve established clinical treatment goals. Treatment sele cted on this basis may have profound effects upon other outcomes, some of w hich, such as improvements in well-being and lifestyle, are of direct benef it to the patient, and others, such as utilisation of healthcare resources and productivity, are of benefit to society. There is, however, evidence th at a large proportion of patients do not achieve the goals of asthma manage ment, such as those appearing in the international guide produced by the Gl obal Initiative on Asthma (GINA). Furthermore, evaluation of the individual guideline goals provides little indication of the level of overall control achieved in individual patients, in spite of the fact that overall or comp rehensive control is likely to be of greater value to the patient than cont rol of only limited aspects of the disease. To give an indication of overall asthma control, and assess whether it is p ossible to reach this target, the GINA goals of asthma management have been amalgamated into a composite measure of overall asthma control. This appro ach has been used to assess recent clinical trials with the fluticasone pro pionate plus salmeterol combination given through a single inhaler compared with alternative treatment approaches. The studies showed that overall ast hma control can be achieved, but at the fixed treatment doses used in clini cal trials by only about half of the patients. Once such measures of contro l are included in management guidelines, healthcare professionals may need help to ensure implementation, using methods such as educational programmes and computerised disease management programmes. Improving asthma control i n this way is likely to be associated with significant economic benefits.