How the current understanding of the pathophysiology of asthma influences our approach to therapy

Asthma can no longer be equated with bronchospasm; instead, we know now that this disease is due to combinations of mucosal edema and inflammation, increased secretions, and muscle contraction. The appreciation of the contribution of these various causes of airflow obstruction and the role that inflammation plays in asthma dictates that we approach treatment using two parallel modalities: (1) symptomatic drugs that act to relieve the airflow obstruction but have no effects on the underlying causes of the disease (e.g., bronchodilators such as beta-adrenergic agonists, theophylline, and anticholinergic compounds) and (2) specific treatment aimed at preventing or reversing the underlying causes responsible for the disease. Four specific treatments are available today: allergen avoidance, immunotherapy, cromolyn sodium, and inhaled corticosteroids. Management of asthma in the 1990s requires that all patients receive specific treatments intended to reduce the disease processes and that symptomatic treatment be used only as necessary.