Issues and advances in the pharmacotherapy of asthma

Evidence is accumulating that inflammation of the airways is directly responsible for the increased bronchial hyperresponsiveness (BHR) and lung function obstruction in asthma. Bronchoprovocation with non-specific, direct bronchoconstrictors (methacholine and/or histamine) can be used as an indirect measurement of inflammation. Thus bronchoprovocation is a useful method for evaluating the long-term benefits of various therapies in asthma. The focus of asthma therapy research is now on the development of anti-inflammatory agents. Inhaled corticosteroids are currently the most potent anti-inflammatory agents in the treatment of asthma and so are generally the most effective in reducing BHR with long-term use. Non-corticosteroid anti-inflammatory agents that are currently available are reviewed. Recent studies have suggested that regular use of inhaled bronchodilators may actually be detrimental in asthma. At this time the data is still inconclusive but certainly warrants the attention of practitioners and requires further research, particularly in relation to the long-acting beta 2-agonists, formoterol and salmeterol.