Future trends in the management of asthma and chronic obstructive pulmonary disease

The strategic approach to the management of asthma and reversible chronic obstructive pulmonary disease employs the use of bronchodilators, corticosteroids, and other agents. A stepped therapeutic approach based upon inhaled beta agonists, long-acting oral methylxanthines and practical steroid strategies is valuable for most patients with reversible asthma and a considerable number of patients with advanced chronic obstructive pulmonary disease. The goals of therapy are a complete or acceptable relief of symptoms and the achievement of the highest possible level of human function, maximal improvement in airflow, and minimal or no side effects from the pharmacologic agents used. The response to therapy from each agent should be carefully assessed by objective measurements of one-second forced expiratory volume and forced vital capacity using simple, practical spirometers. Future trends in asthma therapy include new inflammatory mediator blockers, combined pharmacologic strategies, and other new agents. Future trends in chronic obstructive pulmonary disease include the early identification and intervention with drugs that could reduce or minimize nonspecific bronchial hyperreactivity.