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Asthma Consensus Is Unconvincing to Many

Paul Cotton
JAMA. 1993;270(3):297. doi:10.1001/jama.1993.03510030021004.
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OFFICIALLY there is worldwide agreement on how to treat asthma. In the real world, researchers and clinicians seem to be gasping for consensus the way their patients do for air.

General practitioners and many patients refuse to give anti-inflammatory drugs, especially inhaled glucocorticosteroids, the prominent place in their treatment regimen recommended time and again by randomized, controlled studies and consensus panels around the globe. The thousands of abstracts on asthma at this year's American Lung Association meeting in San Francisco, Calif, reflect both the interest and lack of understanding in this common disease, says Paul O'Byrne, MD, professor of medicine and head of respirology at McMaster University School of Medicine, Hamilton, Ontario.

Wide disagreement on everything from the etiology and mechanisms of asthma to the best and most cost-effective therapy was aired at the meeting.

Steroid Phobia  With the asthma death rate in the United States doubling over the last


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