Asthma is among the most common of all chronic disorders at all ages. Despite increased understanding of cell biology and access to numerous drugs and inhaler, asthma is not under control. One in six people requiring emergency treatment for asthma will require emergency treatment again within two weeks and, sadly, in the UK one person dies of asthma every seven hours. Modern management of asthma is supported by the rigorously evidence-based BTS/SIGN guidelines which are now are updated annually. There is increasing emphasis on starting inhaled steroid for milder cases and using lower doses, the usual starting adult dose is now 400 ug BDP or equivalent. Education using a written personalised Asthma Action Plan is central to good management and should be reinforced at every opportunity. For adults and older children with more troublesome symptoms a LABA is the most effective add-on therapy. Those not controlled at Step 3 should be considered for referral to a specialist hospital clinic.
