Corticosteroid-resistant asthma: pathogenesis and clinical implications for management.

The article by SZEFLER and LEUNG [1] on corticosteroid-resistant asthma is a useful and thorough review of a difficult topic. I am, however, concerned that three different conditions are becoming confused and this could have important implications for therapy. These conditions are: 1) difficult to control asthma; 2) corticosteroidresistant asthma; 3) other respiratory disease incorrectly diagnosed as asthma. These differences are well illustrated in table 1 of the article potential mechanisms for poor response include "Other respiratory disorder" and "Poor adherence". Surely it would be best to reserve the label of corticosteroid-resistant asthma for people who truly have asthma as shown by variability in airflow obstruction, who do not respond to adequate doses of corticosteroids which are truly taken. If the label is extended to include anyone with respiratory disease, which may or may not be asthma, who do not get better with corticosteroids which they may or may not be taking, then muddled thinking will contribute to a difficulty in understanding the nature of the problem and the biological mechanisms behind it. Furthermore, such patients may be given entirely inappropriate treatment because of an inappropriate label.