After asthma: redefining airways diseases

Asthma is responsible for considerable global morbidity and health-care costs. Substantial progress was made against key outcomes such as hospital admissions with asthma and mortality in the 1990s and early 2000s, but little improvement has been observed in the past 10 years, despite escalating treatment costs. New assessment techniques are not being adopted and new drug discovery has progressed more slowly than in other specialties. Transformational thinking about asthmaAlthough asthma has been recognised for thousands of years, the disorder was widely misunderstood until the 20th century.1 The first widely accepted disease definition was released only 30 years ago.2 Although this definition continues to be cited, most clinicians do not actually measure airway inflammation and hyper-responsiveness when they examine a patient with asthma. Yet most patients, clinicians, and researchers claim to recognise “asthma” when they see it—and surveillance programmes continue to document enormous morbidity and costs worldwide. Full-Text PDF Andrew Bush: a broad portfolio in paediatric respirologyAlthough it's trivial, the first thing I notice on meeting Andrew Bush is his colourful bow tie. All sorts of motives are ascribed to men who favour this form of neckwear, and few are entirely flattering. So the succeeding 40 minutes come as a relief. Far from an attention seeker, Bush is a quietly spoken and thoughtful man: a self-declared work junkie with a commitment to paediatric respirology that's equally divided between research and clinical work. “For me, they go hand in hand. It's like someone asking me if I prefer running with my right leg or my left leg. Full-Text PDF Ian Pavord: engaging with the eosinophilIt says something for Ian Pavord's modesty, self-confidence, or both that when talking of the insight with which he's most closely associated, he cheerfully volunteers that it was a rediscovery of something first noted more than 50 years ago. In the 1990s, as a consultant respiratory physician and later an honorary professor at the UK's University of Leicester, Pavord was studying eosinophils and inflammation. He'd acquired an interest in the topic during a fellowship at McMaster University in Hamilton, ON, Canada, where he worked for Freddy Hargreave, an inspirational English physician who, Pavord says, “probably trained more professors of respiratory medicine than anyone else in my era”. Full-Text PDF After asthma: airways diseases need a new name and a revolutionAsthma remains a frightening diagnosis with an unclear prognosis and outcome. The estimated global burden of asthma is substantial1 and reductions in mortality from asthma have stalled since 2006, with wide variations between countries.2 Causes are multifactorial, triggers and symptoms are varied, and the disease course over a lifetime is unpredictable. Severity can fluctuate with sudden asthma attacks leading to death in previously well controlled patients or those with very few symptoms on no medication. Full-Text PDF