Asthma therapy in the nineties: Focus on inflammation

Traditionally, bronchodilators have been the mainstay of therapy for both acute and chronic asthma. However, the important role of inflammation in the pathophysiology of this disease has recently been recognized. Greater emphasis is now being placed on the long-term use of anti-inflammatory therapy to reduce airway inflammation, airway hyperreactivity, and the need for bronchodilator therapy. Aggressive anti-inflammatory therapy-particularly with inhaled corticosteroids-has proven to be effective and well tolerated. The use of other agents with anti-inflammatory properties, including methotrexate, gold salts, and leukotriene receptor antagonists, have all been tried with variable degrees of success and are associated with a variety of side effects. Further studies with these and other novel agents need to be conducted before anti-inflammatory agents other than corticosteroids can be recommended. Educating patients about asthma; asthma medications; and the importance of compliance, peak flow monitoring, and close follow-up has helped reduce the morbidity associated with asthma.