A Commentary: Is Context an Important Consideration in Asthma?

Asthma is a well known and high impact global health problem [1]. It shares, along with other prevalent entities, a number of not insignificant difficulties in the delivery of health care needs for it's control [2]. From a clinical Point of view, the use of inhaled steroid medications (Clinical Efficacy measured as: No. of asthmatics patients controlled /No. of asthmatics patients treated) have proven their worth and are the mainstay of treatment in many Published Guidelines about asthma; and deservedly so. However, from a public health point of view, the clinical effectiveness of such strategies (Clinical Effectiveness measured as: No. of asthmatics patients controlled. Total No. of asthmatic patients) remains a problem around the world [1,3,4]. Many draw backs seems to exist in this over all lack of capacity to deliver comprehensive health care to asthmatic patients and their families. Some of these have been extensively considered, such as: a. need for intensive / recurrent education efforts [1] about the disease and it's treatment; b. the inconveniences with the use of inhaled medications [5]; c. un modifiable housing environmental conditions [3]; d. tobacco smoke exposure [1,3]; e. the culture around poverty and all that it implies [3,4]; f. patient's adherence and the cost of these treatments, among many others.