[Update on treatment of asthma]

Treatment of asthma, in particular long-term therapy, has continued to evolve both for the perfectioning of single classes of drugs and for a better addressed long-term treatment, although physicians have not disposed of new drugs for over 30 years. Only with regard to chromones expectations have been disappointing, as the new nedocromil showed substantially the same efficacy as the old chromoglycate. The recent availability, in paediatrics, of long-acting beta 2 agonists, especially salmeterol, represents a big advantage with regard to compliance in therapies which last months, while the most recent corticosteroid, available in Italy as a spray, fluticasone, would have very few side effects. Principally this is due to the scarce intestinal absorption which is nearly non-existent. An old drug, such as theophylline, has been rediscovered because of the recent evidence of an antiinflammatory action. This is confirmed by the good results obtained when it is used for very long periods instead of inhaled corticosteroids. The therapeutical schemes of asthma have been modified since asthma has been demonstrated to be characterized more by phlogosis of the bronchial mucosa which persists after an acute episode rather than by broncho-constriction. This necessarily requires long-term therapies with antiinflammatory drugs which must be stepwise. In fact, the absence of an ideal drug determines the use of the drug with the fewest side effects in the less severe forms, i.e. chromones although less active, and of inhaled corticosteroids at increasing doses up to steroids per os in the more severe forms. Classical protocols suggest the combination with a beta 2-agonist (when necessary up to 3-4 times per day) to use corticosteroids as little as possible. However, recently short beta 2 agonists are being substituted by long-acting preparation which must be regularly administrated in the morning and evening.