Summary and Recommendations: Highlights of the Asthma Summit 2009: Beyond the Guidelines

Despite intense attention over the past 10–20 years, asthma still offers many potential new targets and approaches for improved treatment. Bronchospasm is the most obvious target, which is amenable to treatment that relaxes airway smooth muscle. Inflammation is the most emphasized aspect of the disease and is used to direct maintenance therapy at the underlying facets of asthma. However, emerging evidence indicates that inflammation itself represents a more complex target than previously understood. The inflammation of asthma is multicellular, and responses to treatment can vary by cell type, so that treatment approaches should be expanded to reflect these differences between individual patients. In addition, no currently available therapies address injury repair, which is also multicellular and contributes to progressive loss of lung function, a component of risk. It is also apparent that personalized and flexible treatments for patients with asthma are equally important. In fact, many patients are already practicing their own “brand(s)” of personalized and flexible therapy; as indicate by refill rates for short-acting bronchodilators and maintenance medications. It is widely recognized that full compliance with recommendations is only occasionally followed by many, if not most, asthma sufferers. One important outcome of the discussion at the Asthma Summit was that physicians who treat patients with asthma should be willing to work with patients to develop flexible options for treatment that maintain optimal asthma control. This approach requires patient education, regular evaluation of asthma control, is best done in conjunction with home peak flow monitoring, and requires consideration of a range of treatment options that make sense for the individual patient. Specific recommendations from the Asthma Summit toward this goal include the following: