USE OF ASSESSMENT OF INFLAMMATION IN MANAGEMENT OF DRUG-THERAPY IN ASTHMA

As it has now been accepted that asthma is an inflammatory disorder, t reatment strategies have been changed and early intervention with anti -inflammatory agents, especially inhaled corticosteroids, has been str ongly advocated. However, in each patient a risk-benefit balance shoul d be considered, Therefore, it is essential to make use of tools for a ssessing the status of inflammatory activity in the airways in order t o evaluate the effectiveness of the therapeutic management in a patien t. Symptoms have always been a key marker, but they do not offer a sen sitive tool. Lung function testing can add an objective measure of the disease status, of which forced expiratory volume in 1 second (FEV (1 )) is the most reliable, and peak expiratory flow the easiest for day- to-day monitoring. However, as these indirectly estimate the activity of the inflammatory process, attempts are being made to establish more direct methods of assessment. Such direct methods include determinati on of the number and type of inflammatory cells and measurement of the ir products in body fluids, e.g. sputum induction and analysis of its contents and eosinophil cationic protein (ECP) in serum. The latter se ems to be a promising inflammatory marker, which can easily be measure d in the clinical setting. There are strong indications that elevated levels of serum ECP point to inflammatory activity in asthmatic diseas e. The value of ECP measurements along with the assessment of symptoms and lung function should be further studied with the aim of achieving maximum control of asthma with a minimum level of drug therapy.