Re-defining Asthma – What’s all the fuss about?



Re-defining Asthma – What’s all the fuss about?

Kian Fan Chung

National Heart & Lung Institute, Imperial College London, & Royal Brompton Hospital, London, UK


Asthma is a descriptive term that has been used over the centuries to denote a condition that is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, without any assumption of pathophysiology. Under this definition many other conditions apart from asthma may be diagnosed but with the later ability to measure lung function, the addition of variable expiratory airflow obstruction brought more precision to its diagnosis. More recently, recognising the importance of airway inflammation as associated with causing the symptoms of asthma, its presence was another useful differentiating property. The recognition that eosinophilic inflammation was commonly associated with symptomatic asthma led to the use of inhaled steroids as being the most important anti-inflammatory management of asthma, and together with inhaled long-acting beta-agonist bronchodilators formed the basis of treatment for all asthmatic patients with the dose of these anti-asthma drugs dosed according to the degree of severity of the asthma (