The majority of diseases that we have to deal with present few problems of definition. In the case of asthma, however, despite the description of the Ciba Guest Symposium in 1959, the further characterization by the American Thoracic Society (ATS) in 1962, and the many successive and regular attempts to define it by several authors, an unambiguous definition has not been widely agreed. The aetiology is still obscure, the clinical picture is diverse with the major problem of adequately separating asthma from chronic obstructive pulmonary disease (COPD), and the pathophysiological mechanisms are seemingly multiple. Despite several proposed criteria (clinical, physiological, immunological and more recently histological and biochemical) there is still no gold standard for defining asthma. Our previous results, confirmed by several authors, document that there is no test, particularly nonspecific bronchial challenge, that has a certain place in the diagnosis of the disease and which could enter in to the definition. This may not represent a problem in clinical practice, because starting from symptoms, different tests may be arranged (reversibility of airways obstruction, or bronchial reactivity, or exercise testing, or diurnal variation of peak flow rates etc.). However, to leave asthma undefined may give rise to difficulties for research and publication: in this case, precision, probably does not lie in defining a label but in accurately describing the characteristics of the subjects who were studied. However, the lack of uniformity between investigators in their manner of defining asthma, and of a standardized diagnostic test, has clearly handicapped epidemiological studies of the disease. Although, in several countries, an increase in admission to hospital, prescriptions for medication, visits to doctor and prevalence both of morbidity and mortality from asthma is reported, the real extent of the problem seems to vary greatly. The lack of agreement in defining the criteria by which the disease is identified makes it difficult to interpret this increase, and its variability. The extent of such variations, if confirmed, is of considerable importance in evaluating the role of the environment and way of life of the local population in the pathogenesis of asthma. In conclusion, more than 10 yrs later, we can probably still agree with the title of the famous Editorial (Gross, 1980, Am Rev Respir Dis) 'What is this thing called love? - Or, defining asthma'.
|Number of pages||4|
|Journal||European Respiratory Review|
|Publication status||Published - 1993|
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine