Step care therapy: a logical approach to asthma management.

Abstract

In the decade of the 1980s, physicians have significantly changed their approach to both their understanding and treatment of asthma. It is not clear if this is related to the increasing rates of morbidity and mortality worldwide with asthma or if it has simply been a function of a better understanding of the pathophysiologic events associated with this disease. Until recently, asthma was primarily thought of as a disease in which the airways had an obstructive process which caused the individuals to have wheezing and shortness of breath. This oversimplified concept has been expanded dramatically, and it is now recognized that inflammation leading to increased bronchial reactivity is the basis for which airways react and become obstructed. The role of inflammation in asthma has been so emphasized that one leading investigator has recently described asthma as “chronic desquamative eosinophilic bronchitis” (1). This terminology takes the asthmatic one step further in understanding the pathophysiologic relat...