Asthma

Lancet Commission to address asthma stagnation


The Lancet has launched a Commission on asthma in the hope of liberating airway diseases from the “intellectually destitute umbrella term ‘asthma’”.

It will also examine why after 20 years therapy has not advanced “from the blue and brown inhaler, measurement of urinary cotinine, and looking menacingly at the pet cat.”

The Commission is predicated on the assumption that “asthma” is no more a 21st-century diagnosis than “arthritis” says Andrew Bush who gave the Wunderley Oration at last week’s TSANZSRS conference.

“We will attempt to liberate this mix of airway diseases from the protective but intellectually destitute umbrella term “asthma” with the aim to progress management to the level that is commonplace in rheumatology.”

The Commission aims to stimulate discussion and progress by addressing three key questions:

Where are we now with this disease called “asthma” and why is it such a bad place? Where do we think we want to go? And how will we get there, learning from our mistakes.

The five groups of topics that will be covered by the Commission are: (1) definition, clinical features, diagnosis, phenotypes, management; (2) epidemiology, public health, environment; (3) paediatrics, early life, genetics; (4) severe asthma; and (5) pathogenesis and animal models.

“Perhaps ambitiously, we want to propose a revolution in thinking about airways disease, which, alongside the undoubted importance of optimum delivery of the best care to each patient, will deliver real personalised asthma medicines, dissecting airways disease into its components and addressing each in turn, stratified by risk.”

The members of the Lancet Commission on the asthmas are: Gary Anderson, Richard Beasley, Elisabeth Bel, Guy Brusselle, Andy Bush, Paul Cullinan, Adnan Custovic, Francine Ducharme, John Fahy, Urs Frey, Peter Gibson, Liam Heaney, Pat Holt, Marc Humbert, Clare Lloyd, Guy Marks, Fernando Martinez, Ian Pavord, Peter Sly, Erika von Mutius, Sally Wenzel, and Heather Zar.

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