A historical perspective: Are inhaled corticoids sufficient to control asthma?

Inhaled corticoids (ICS) made a dramatic breakthrough in the management of asthma in the late eighties resulting in a sharp reduction in morbidity and mortality in the following decades. Soon after, the association between ICS and long acting β2 agonists (LABA) soon became the gold standard of maintenance asthma treatment. With the advent of sputum induction it has become clear that asthma could not be considered as a unique entity but rather a display of several inflammatory phenotypes. Eosinophilic phenotype shows good response to ICS while non-eosinophilic, and in particular the neutrophilic phenotype, seems to be more resistant. Severe asthmatics show insufficient asthma control despite ICS/LABA. Those who are allergic and eosinophilic may benefit from add-on treatment with anti-IgE or anti-IL-5. Severe neutrophilic asthma could benefit from maintenance treatment with macrolides while thermoplasty offers some promise to those in whom airway smooth muscle hypertrophy contributes to disease instability.