Unconventional approaches to drug therapy in severe asthma

Asthma is now considered as an inflammatory disease. A subset of severe asthmatic patients requires large doses of daily systemic steroids to achieve some control of the inflammation of the airways. To minimize the daily absorption of glucocorticoids, a number of medicaments have been studied for the last three decades. Methotrexate, dapsone, hydroxychloroquine, ciclosporine A, gold salts, intravenous gammaglobulins, ketotifen, triacetyloleandomycin, all demonstrated some positive effects in a small number of studies. However, our impression is that most "steroid-sparing" medications are either poorly effective in large series and/or have intolerable side effects in these chronically ill patients; many are very expensive. A revised, adjusted therapeutic strategy, using currently recommended anti-asthmatic drugs, making a major use of inhaled topical corticosteroids, should limit the number of "cortico-dependent" asthmatic patients.