The role of atopy in asthma

Allergy plays an important role in chronic asthma. Aeroallergens, both indoor and outdoor, provide a constant source of bronchial inflammation that increases bronchial hyperreactivity. This increased reactivity lowers the threshold of response to nonspecific triggers of asthma flares such as viral infections, pollutants, and cold air. Asthma is a chronic inflammatory disease in much the same way that the rheumatic diseases are. In that respect, therapy should be directed at reducing inflammation, as it is in the rheumatic diseases. Along these lines, newer approaches to asthma therapy should emphasize steroids as first-line treatment. In this way, therapy is targeted against the underlying inflammation that causes the bronchial obstruction, rather than treating with bronchodilators such as theophylline and B agonists. The effect of such continuous antiinflammatory therapy is decreased airway hyperresponsiveness, which has obvious clinical benefit.