Abstract
Asthma guidelines focus on day-to-day control of symptoms. However, asthma attacks remain common. They continue to cause mortality
and considerable morbidity, and are a major financial burden to the UK National Health Service (NHS) and the wider community. Asthma
attacks have chronic consequences, being associated with loss of lung function and significant psychological morbidity. In this article we
argue that addressing daily symptom control is only one aspect of asthma treatment, and that there should be a more explicit focus on
reducing the risk of asthma attacks. Management of future risk by general practitioners is already central to other conditions such as
ischaemic heart disease and chronic renal impairment. We therefore propose a revised approach that separately considers the related
domains of daily control and future risk of asthma attack. We believe this approach will have advantages over the current ‘stepwise’
approach to asthma management. It should encourage individualised treatment, including non-pharmacological measures, and thus may
lead to more efficacious and less harmful management strategies. We speculate that this type of approach has the potential to reduce
morbidity and healthcare costs related to asthma attacks.