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Pharmacological treatment of asthma today

Leiden University Medical Centre, Dept of Pulmonology, Leiden, the Netherlands

CORRESPONDENCE: K.F. Rabe, Leiden University Medical Centre, Dept of Pulmonology, C3-P P.O. Box 9600 NL-2300 RC, Leiden, The Netherlands. Fax: 31 715266927

Keywords: Asthma, ß₂-agonist, corticosteroids, leukotriene antagonists, pharmacology

Received: June 14, 2001
Accepted June 20, 2001

The current concept of asthma therapy is based on a stepwise approach, depending on disease severity, and the aim is to reduce the symptoms that result from airway obstruction and inflammation, to prevent exacerbations and to maintain normal lung function.

ß₂-Adrenoceptor agonists and glucocorticoids are at present the most effective drugs for the treatment of airway obstruction and inflammation, with theophylline, leukotriene receptor antagonists and anticholinergics as second- or third-line therapy. There are, to date, no additional or newly developed drugs available that add substantially to the current strategies or even replace ß₂-adrenoceptor agonists or glucocorticoids. New approaches in asthma therapy recommend drug combinations of inhaled steroids, primarily with long-acting ß₂-adrenoceptor agonists, based on their improved efficacy and the potential for a steroid-sparing effect.

Although existing drug entities are able to control the vast majority of patients with mild and moderate asthma, patients' (and doctors') adherence to guidelines and treatment strategies falls well short of the desired standards.

Treatment choices, however, differ between countries and should take into account convenience to the patient and the occurrence of side-effects. Additionally, the cost of therapy and reimbursement policies also influences therapeutic strategies.