Asthma can be a variable disease, particularly when uncontrolled. Therapy, therefore, should be tailored accordingly. The aim of a study by Elrik and coworkers was to explore patterns of self-management in response to disease variability in adult patients with asthma. Five hundred and nine adults with asthma were recruited through a web-based panel. They were asked to answer a questionnaire concerning asthma knowledge, compliance, and treatment, including specified treatment options, via the Internet. Two-thirds of the patients on inhaled corticosteroids stepped-up and down their daily dose without prior contact with their doctor, and more than 50% took less inhaled corticosteroids than prescribed during periods with fewer symptoms. In case of deterioration, 57% of the patients increased their reliever medication, whereas 23% also increased their controller medication. Fifty-nine percent of the patients were instructed by their doctor to do so. The self-perceived severity of asthma (graded as mild, moderate or severe) was not associated with the patients' response pattern. The preferred treatment strategy, differing primarily with regard to dosing and timing of controller medication, was associated with feeling safe about self-adjustment of controller medication, but not with self-reported knowledge of asthma.

VALUE OF STUDY TO YOU AS A HEALTH CARE PROVIDER: In case of deterioration of their asthma, the majority of adults increased their reliever medication and, as instructed by their doctors, also increased their controller medication. The patients' preferred strategy for management of disease variability did not seem to be driven by their knowledge of the disease.

VALUE OF STUDY TO YOU AS A PROVIDER: If you have asthma, your health care provider has likely told you when and how often to use your quick relief medication. The problem here is that too many patients still overuse this type of drugs. Increasing or decreasing the controller drugs you take, however, is a strategy that requires discussion and agreement between patients and their health care provider. If you think you should increase or decrease inhaled corticosteroids, your physician must work with you to develop tactics that are tailored to your needs. These recommendations can then be incorporated into the self-management skills you use to control your asthma.

CS Elrik et al. Disease variability in asthma: how do the patients respond?--and why? Journal of Asthma, 2008;45:507-511.