5.9.6. Future Developments

Asthma is a significant burden, not only in terms of health care costs and lost productivity but also of quality of life impairment. Asthmatic symptoms deeply influence individual lifestyle: acute asthma episodes are for many people somewhat unpredictable and can be more stressful than events that can be anticipated and prepared for. Feeling that another asthma episode could start at any time may cause a person to feel constantly anxious. Aspects of having asthma such as using an inhaler or avoiding triggers, as well as the asthma symptoms themselves, can make a person feel different and set apart from other people. This is why Health Related Quality of Life (HRQoL) has become a fundamental instrument for achieving a complete description of asthma, focused not only on clinical data but also on the impact the disease and its therapy as perceived by patients (Schipper et al, 1990). Quality of life research has demonstrated the importance of adopting specific criteria permitting the integration of the objective evaluation of asthma symptoms with the subjective perceptions of the patient. The assessment of HRQoL in asthmatic patients has been attracting an increasing interest during the last two decades. Many questionnaires have been created to evaluate the impact of asthma from the patients’ point of view (Baiardini et al, 2006). HRQoL is assessed by means of validated questionnaires, that can be generic or specific: generic tools can be used in all health conditions and allow the comparison of HRQoL of patients affected by different diseases with healthy subjects, while specific questionnaires focus on the aspects of health status relevant for patients with a specific disease or clinical condition.

The importance of this point is confirmed by the international guidelines for asthma: the Global Initiative for Asthma (GINA) document (GINA, 2006). Global strategy for asthma management and prevention considers HRQoL as a relevant issue for the search of healthcare intervention and the choice of appropriate treatment (WHO, 1952).

GINA guidelines underline the importance of prevention strategies in controlling symptoms and improving the quality of life in asthmatic patients: measures for prevention of allergic sensitization, asthma development and exacerbations should be implemented whenever possible. Allergic sensitization can occur prenatally, but at present there are no strategies to prevent allergic sensitization; the role of allergen-free diet for high risk woman in pregnancy is still unclear, even if breastfeeding seems to protect against the development of wheezing illnesses in early childhood. GINA is a partner organization of the Global Alliance against chronic Respiratory Diseases (GARD) (Bousquet et al, 2006), a WHO initiative aiming at facilitating the collaboration among existing programs regarding chronic respiratory diseases. The participating organizations will develop a new global approach towards prevention and control of chronic respiratory diseases, with a particular emphasis on developing Countries.

For what concerns allergic rhinitis, the ARIA organization (Allergic Rhinitis and its impact on Asthma), an organization, working in partnership with WHO, has provided the first set of guidelines to be used worldwide for what concerns treatment and evidence-based recommendations (Bousquet et al, 2006). ARIA goals for both specialists and primary caregivers are to improve the management of allergic rhinitis and to complement the GINA guidelines, the gold standard for the management of asthma. ARIA highlights the impact of allergic rhinitis on asthma, that are common comorbidities, suggesting the concept “one airway, one disease”. Hopefully, ARIA guidelines will improve a better understanding of the interactions between allergic rhinitis and asthma, increase the awareness of the socio-economical impact of rhinitis and make effective treatment for rhinitic symptoms available for every patient in the world.