Newer and alternative non-steroidal treatments for asthmatic inflammation

Although most patients with asthma can be effectively managed with minimal toxicity using available treatments, some patients are relatively resistant to treatment or are at risk for adverse effects from treatment, such as high-dose systemic corticosteroids. In considering new or alternative therapeutic candidates for asthma treatment, those possessing anti-inflammatory properties are of greatest interest because inflammation is recognized as having central importance in the pathogenesis of persistent asthma. Of non-steroidal agents that have well-established positions in asthma treatment, nedocromil and cromolyn possess significant anti-inflammatory effects, and theophylline and beta agonists possess some anti-inflammatory effects of potential relevance to asthma. In addition, there are a number of newer or alternative therapies that have theorized or demonstrated anti-inflammatory effects in asthma, including leukotriene modifier agents, anti-IgE, gold, nebulized lidocaine, cyclosporine, intravenous immunoglobulin, methotrexate, hydroxychloroquine, dapsone, and troleandomycin. This review summarizes available data about these agents for asthma, focusing on their putative or proven mechanisms of action, evidence for clinical benefit, and their potential role as corticosteroid sparing agents, and principal toxicities. The review also discusses factors that confound assessment of the clinical benefit of agents in asthma, including variability in the natural history of asthma, heterogeneity of airway inflammation, and varying responses to treatment in different subsets of asthmatics.