EVOLUTION OF ASTHMA TREATMENTS

The treatment of asthma has undergone dramatic changes in the past two decades. These changes stem from the marked increase in our understanding of the pathophysiology of asthma as well as from the availability of potent and effective therapeutic agents. This review discusses the current treatment of asthma considered from a pathophysiologic perspective, focusing on the roles of specific and symptomatic approaches. Specific therapies are aimed at the underlying processes causing asthma, with the goal of reducing symptoms and the need for concomitant medication. Choices include allergen avoidance, immunotherapy, inhaled cromolyn or nedocromil, and inhaled or oral corticosteroids. Symptomatic therapies that control the symptoms of asthma without affecting the underlying causes are used alone or to provide coverage in the period before specific therapies take effect. Here the options are beta agonists, theophylline, and anticholinergic agents. This article weighs the advantages and disadvantages of each of the principal therapies and discusses today's major controversies, including the link between beta-agonist use and asthmatic deaths, theophylline toxicity, and the efficacy of immunotherapy.