CLINICAL MANAGEMENT OF ASTHMA IN THE 1990S - CURRENT THERAPY AND NEW DIRECTIONS

Asthma is a serious global health problem affecting nearly 100 million people worldwide. Its rising prevalence and associated morbidity and mortality are of increasing concern. Traditionally, symptomatic contro l of bronchoconstriction with beta(2) agonists and theophylline has be en the mainstay of therapy. However, during recent years, inflammation has been recognised as the predominant cause of reversible airway obs truction and airway hyperreactivity. As a result, the emphasis in trea tment has shifted to the early use of inhaled corticosteroids to contr ol airway inflammation. beta(2) agonists are best used on an as-needed basis for the relief of acute bronchoconstriction and for the prevent ion of exercise-induced asthma. Sustained release theophylline or an i nhaled long-acting beta(2) agonist may effectively control nocturnal s ymptoms. Preliminary studies involving agents active in the 5-lipoxyge nase pathway as preventive therapy are encouraging. Further studies ar e needed to define their role in the management of asthma.