Pharmacologic Treatment of Asthma


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.
β2‐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 β2‐adrenoceptor agonists or glucocorticoids. New approaches in asthma therapy recommend drug combinations of inhaled steroids, primarily with long-acting β2‐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.
Bronchial asthma is an inflammatory disease of the airways, characterized by bronchial hyperresponsiveness and variable airway obstruction. Current pharmacotherapy aims primarily at symptomatic improvement through the use of bronchodilators and suppression of airway inflammation and decrease of bronchial hyperresponsiveness through the use of anti-inflammatory therapy.
The goal of the current and established treatment of asthma is minimization of symptoms, maintenance of normal lung function and prevention of irreversible changes within the airways. In future, it will be important to develop preventive and, possibly, curative therapeutic approaches, which are based on an improved understanding of the pathogenesis and pathophysiology of asthma.
Current treatment strategies advocate a stepwise approach to treatment, which depends on the severity of the disease 1. This classification requires a standardized clinical assessment as well as measurement of lung function. Current pharmacotherapy should provide adequate control for the majority of patients; however, implementation of current guidelines, including lung function measurement and rational therapy, still falls well short of the desired standards

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