[A modern approach to the treatment of bronchial asthma]

The view on etiopathogenesis of bronchial asthma has changed considerably in recent years. Bronchial asthma is now understood as an inflammatory disease of the airways which show characteristic pathologic features: infiltration of the airways with inflammatory cells (especially eosinophils and T lymphocytes), epithelial shedding, airway smooth muscle thickening, subepithelial fibrosis, mucus gland and goblet cell hyperplasia with hypersecretion of mucus. Classification based on etiology unfortunately has not the immediate influence on the treatment of patients with asthma and therefore classification based on severity of disease was approved by several international consensus reports, which divide asthma into four groups: intermittent asthma, and mild, moderate and severe persistent asthma. From the second step (mild persistent asthma) antiinflammatory drugs are considered as the first line therapy, of which inhaled glucocorticosteroids are both in adults and children the most effective controllers. There is increasing evidence that early intervention with inhaled corticosteroids can prevent development of irreversible airway obstruction. Most patients with asthma can get their disease under optimal control and reach the goals of treatment by long-term management in the stepwise approach. Self-monitoring and regular follow-up with ongoing education is one of the most important part of long-term management program.