[Perspectives in future asthma therapy]

Five to ten percent of all asthmatics, many dozens of millions of patients all over the world, do not respond to maximal medical therapy, including systemic steroids, and the toll of treating them constitutes about eighty percent of the total cost of managing all asthmatics. Other asthmatics who do respond to medical therapy either are not compliant with their medications or suffer from disabling adverse effects. The future therapy of asthma will concentrate on finding medical solutions to these sub-groups of patients but the entire asthmatic population will enjoy its achievements. The future trends in asthma therapy include immunomodulation, managing receptors and inflammatory mediators that are crucial in asthma pathogenesis, formulation of custom-made medications using individual pharmacogenetics, elaborated specific immunotherapy of atopic rhinitis, development of "smart inhalers" and sophisticated techniques in aerosol transportation to the airways, and bronchial thermoplasty which has only recently been approved. The daily clinical implications of these trends will probably unfold in the next five to fifteen years.