Rates of asthma as well as the burden of this chronic disease are increasing, despite important advances in research. This paradox raises two distinct issues: the increase in asthma over the last 15 years, and the continuing hardships for those who already have the disease.
Why are rates of asthma increasing? Why is the burden of asthma still so great?
If there have been breakthroughs in understanding the mechanisms of the disease, why are rates of asthma increasing? One key reason is that the cause of the asthma epidemic in the United States, which is also affecting most industrialized countries, is not known. Further research is needed to clarify the genetic basis of susceptibility to asthma, and the biologic mechanisms that explain the interactions of susceptibility and other factors, such as environmental exposures, that lead to asthma. While this basic research requires additional emphasis, we also need to proceed with testing possible approaches to prevent asthma based hypotheses derived from basic and epidemiological studies. Both basic research and prevention trials can help identify promising strategies to prevent the disease from occurring in the first place.
If the tools exist to manage asthma more effectively, why is the burden of asthma still so great ? Although progress has been achieved in professional and patient education in the past decade, and research has shown that effective medical management and patient education reduces the use of emergency services and improves quality of life, many health care professionals and people with asthma are not making use of the Guidelines (60, 61, 62, 63). Various outstanding programs supported by federal and private funds have helped foster needed changes in medical practice and patient behavior, but these need to be evaluated in a greater variety of settings and implemented on a larger scale in order to have national impact. Populations and neighborhoods experiencing the greatest burden of disease often lack access to high quality medical care, including adequate education about asthma manag e ment and sufficient medications and equipment (24, 62, 64). Poor housing and environmental conditions make it difficult to control exposures that worsen asthma . In addition, lack of asthma surveillance at the State and local levels hampers public health efforts to direct quality health care toward the most severely affected populations.
In summary, we have made progress but we are not yet close to understanding the causes of the asthma epidemic nor to providing optimal care. In the meantime, we need to 1) improve the availability of quality asthma care, especially to underserved populations, which is feasible and can be done by a coordinated effort; and 2) increase research efforts to deal with chronic persistent asthma and to prevent the onset of the disease.