Research and Asthma: Where Do We Go From Here?

Abstract

In this issue of the Journal, Finkelstein and colleagues1 have outlined the failure of pediatricians and family practitioners to adhere to many of the recommendations of the National Institutes of Health (NIH) asthma guideline.2Although more detailed than previous reports, this study is consistent with a number of others that have documented inconsistencies between physician practice and the NIH asthma guideline.3,4 Where do we stand with respect to clinical and health services research and asthma in children? There are a number of important questions that remain unanswered. The diagnosis of asthma in children <2 to 3 years old can be complicated and elusive. Unfortunately, the NIH asthma guideline is not helpful with respect to making the diagnosis in young children.2 The majority of diagnostic criteria are only relevant for older children, adolescents, and adults. If an 18-month-old child wheezes twice, 6 months apart, does he or she have asthma? Does the diagnosis change if there is a family history of asthma and the child has atopy? Ensuring appropriate therapy for asthma is obviously dependent on a secure diagnosis. It is not yet clear how we make the diagnosis of asthma in young children. The NIH guideline is predicated on diagnosing asthma accurately and then categorizing the patient appropriately with respect to severity. The most important groups to …