DEVELOPMENTS IN THE TREATMENT OF BRONCHIA L-ASTHMA - FOCUSING ON CLINICAL NEEDS

Modern treatment of bronchial asthma needs to be individually tailored due to the patient's and his asthma's needs. Such treatment includes regular consultation between pulmonologist, general practitioner and p atient concerning effects and side effects of the treatment and includ es repeated education of the patient as well as critical assessment of the efficacy of any current therapy. Monitoring of therapy as well as minor shea term adjustments called self-assessment and self-managemen t should be taught to the patient. The aim of anti-asthma therapy toda y is virtual absence of any asthmatic symptoms yet maintaining a norma l life without restrictions in physical activities. Thus hospital admi ssions either for adjustment of therapy or due to severe exacerbations can be avoided in the vast majority of cases. Recent research in infl ammation in asthma underscores the importance of anti-inflammatory tre atment of asthma as first line therapy including sodium cromoglycate a nd nedocromil especially in children but inhaled corticosteroids espec ially in adults. Newer inhaled steroids such as fluticasone with a gre ater therapeutic index will improve this form of treatment. It still r emains unclear whether regular beta-agonist therapy is harmful in asth ma yet currently on demand therapy should be preferred instead of regu lar dosing. Due to experimental evidence suggesting anti-inflammatory activity theophylline has regained a place in the treatment of chronic moderate to severe asthma, especially during the night. Systemic cort icosteroids should be reserved for patients with severe or intractable asthma and severe acute exacerbations. Slow-release i.m. corticostero ids are obsolete in the treatment of asthma and related allergic condi tions. New classes of therapeutics such as the leukotriene-antagonists will probably change anti-asthma therapy profoundly. Yet their precis e role still remains to be determined.