Can fatal asthma be prevented?--a personal view.
An increase in the mortality rate from asthma in several countries has been observed in recent years, notwithstanding the great improvement in pathophysiological findings and the introduction of new effective therapeutic agents. The phenomenon is difficult to explain but the causes of death and identification of high-risk patients have been widely studied. It is suggested that the most vital aim for physicians is the avoidance of those factors which may contribute to death from asthma. These are particularly: inadequate assessment of its severity by patients, general practitioners and hospital doctors, and inadequate and inappropriate treatment. From the diagnostic point of view, the measurement of airflow rates is necessary to establish the diagnosis in terms of reversibility, quantify the severity and assess the response to therapy. The different entity of reversibility of bronchial obstruction is due to the various mechanisms intervening in different patients. After adequate treatment, according to our observations, the reversibility is more complete in young people and when the duration of the disease is less than 2 years. Trigger factors must also be considered. From the therapeutic point of view, considering that the most important alteration in asthma is the inflammation of bronchial structures with intervention of several inflammatory cells and of numerous different chemical mediators, physicians have to apply treatment aimed at reducing inflammation rather than relying on symptomatic bronchodilator remedies. Treatment should be divided into three phases, according to symptoms: induction, consolidation and maintenance. Finally, on the basis of data here presented and of clinical experience, the essential measures for the prevention of asthma mortality are reported. If general practitioners take them into account, deaths from asthma will be reduced to a minimum.