Asthma pharmacotherapy: current practices and outlook

Owing to its high incidence and rapidly increasing prevalence in the United States population, and to the billions of dollars in associated costs, asthma is a significant public health problem. A variety of pharmacologic agents exist to manage asthma, but their efficacies vary, as do their costs. Recently published guidelines on asthma management set forth a four-step approach that is guided by severity of disease and symptom control. These guidelines also suggest increased use of antiinflammatory agents, primarily inhaled corticosteroids, which carry a higher cost. Shifts in prescribing patterns among physicians who treat patients with asthma indicate that the guidelines are being adopted to some extent. However, some reluctance toward widespread use of corticosteroids remains, due to potential adverse effects as well as cost considerations. Alternatives to increased or high-dose corticosteroid use include combination therapy with long-acting bronchodilators. Newer medications that have more specific mechanisms of action, such as leukotriene synthesis inhibitors and leukotriene receptor antagonists, may offer another option.