Volume 47 (1998) Issue 4 Pages 237-246
Inhaled corticosteroid therapy remains the basis for the treatment of chronic asthma. Recent understanding of its use includes the benefits of early introduction, and of its plateaued dose-benefit effects. Additional beneficial effects on asthma control and prevention of asthma exacerbations can be obtained by combining middle-to high-dose inhaled corticosteroid with long-acting β-agonists and slow-release theophylline. Leukotriene inhibitors, particularly leukotriene receptor antagonists, are novel treatments that may also be combined with inhaled steroid therapy. Although current asthma treatments are very effective, a subgroup of asthma patients (difficult or therapy-resistant asthma) do not respond adequately to these treatments and need maintained oral corticosteroid therapy. New asthma treatments are particularly needed for this group. New treatments for asthma include more potent topical corticosteroids which have less potential for side-effects, inhibition of eosinophil chemotaxis and activation such as anti-IL-5, anti-eotaxin, eotaxin receptor antagonist, anti-VL-A4, anti-IgE therapy, restoring Th-1/Th-2 balance either by increasing Th-1 or reducing Th-2 T-cell activity, anti-inflammatory cytokines such as IL-10, and specific inhibitors of PDE4. These treatments may be considered as either controllers, remitters (inducing remission of disease), or preventors according to their modes of action and their clinical effects. Currently, there does not appear to be any prospect of a cure for asthma.