TY - JOUR T1 - Investigating the steroids and long-acting β<sub>2</sub>‐agonists combination: why do we need more? JF - European Respiratory Journal JO - Eur Respir J SP - 501 LP - 502 DO - 10.1183/09031936.04.00129104 VL - 23 IS - 4 AU - A. Papi Y1 - 2004/04/01 UR - http://erj.ersjournals.com/content/23/4/501.abstract N2 - Clinicians and scientists should work together, as the understanding of molecular mechanisms of diseases may help clinicians to improve their clinical practice. This is clearly exemplified by the studies on clinical and molecular interactions between long-acting inhaled β2‐agonists (LABA) and glucocorticoids in the treatment of asthma and chronic obstructive pulmonary disease. Indeed, the possibility of obtaining a drug synergism combining in a single inhaler, LABA and inhaled glucocorticoids, in the regular long-term treatment of moderate-to-severe persistent asthma in adults has intrigued many clinicians and scientists in the last few years. Inhaled β2-agonists are the most effective bronchodilators, and inhaled glucocorticoids the most effective anti-inflammatory drugs currently available for the treatment of asthma in adults. Since 1994 1 many controlled clinical trials have conclusively demonstrated that the inhalation of a combination of low-dose glucocorticoids together with a LABA has at least the same efficacy as doubling the dose of the inhaled glucocorticoids in the long-term treatment of moderate-to-severe persistent asthma in adults 2. Conventional wisdom had been that glucorticosteroids and LABAs act through separate and distinct pathways. Studies on the efficacy of inhaled glucocorticoids in the treatment of asthma have demonstrated that they have a relatively flat dose/response curve with most of the benefit obtained at the lowest doses 3, 4. The flatness of the dose/response means that the inflammation is suppressed by a relatively low dose of glucocorticoids. The addition of β2‐agonists may exert some additional actions on the airways that is complementary to the effect of glucocorticoids. In vitro and in vivo data … ER -