No symptoms, no asthma

It is widely recognized (at least by physicians and scientists) that asthma is a chronic disease. In a simplified view, ongoing inflammation in the lung underlies contraction of smooth muscle which causes symtpoms. Blocking or treating the underlying inflammation, by means such as allergen avoidance and use of inhaled steroids, helps prevent exacerbations triggered by things like exercise, viral infections and exposure to allergens (think cat).

Patients, however, may not share this view, believing instead that they only have asthma when they are having symptoms. Thus one of the hardest things asthma doctors face is convincing patients (or thier parents) that they need medicine everyday when they only have symptoms intermittently. Even when we think we've explained ourselves, patients often returns saying they stopped the medicine because they were all better.

Halm et al. have now shown just how prevalent that belief can be; more than 1/2 of patients HOSPITALIZED with asthma at Mt. Sinai in New York City believe that they only have asthma when they have symptoms. This even though 1/4 of the sample has been intubated for an asthma exacerbation in the past.

This helps explain why many patients are resistant to use of daily controller medications to prevent asthma flares.

They authors identify the question "Do you think you have asthma all of the time, or only when you are having symptoms?" as an effective means of identifying patients who need further education.

My only criticism of the study is that it doesn't tell us much about the level of persistent symptoms the patients have. If you have symptoms most or all days, which many of these patients presumably do, the idea that you only have asthma when you have symptoms may not be relevant. The authors do show that among patients with daily symptoms, the "no symptoms, no asthma" belief is less common.