Early treatment of asthma

The early treatment of asthma was not greatly studied before the 1990s. Sub jects included in intervention trials have usually had persistent asthma wi th a long duration of symptoms. Only a few studies have been done on early intervention. It has also become obvious that eosinophilic airway inflammat ion is common and does not always significantly affect lung function. If pa tients do not fulfill the functional criteria for asthma, they may not rece ive specific diagnosis and effective treatment. have suggested the term "as thma-like inflammation" to describe the disorder of such patients. Bronchia l obstruction and increased bronchial responsiveness are outcomes of the in flammatory process, and it may be argued that detection of eosinophilic inf lammation is always late at the time asthma is diagnosed. The diagnosis of asthma is often severely delayed, a fact which influences the prognosis and efficacy of therapeutic interventions. The benefits of early treatment of symptomatic asthma have been shown, and several international guidelines re commend anti-inflammatory medication, preferably with inhaled steroids as f irst-line treatment to gain control of the disease as fast as possible. Ver y few studies, however, have addressed the long-term influence of various t herapeutic approaches. Usually, the beneficial effects gradually disappear when treatment is withdrawn. There is no convincing evidence that any of th e current pharmacologic therapies can change the natural course of asthma. Nevertheless, inhaled steroids seem to have a disease-modifying effect if s tarted early enough, and there is a consensus that steroids abolish symptom s, improve lung function, and decrease the need for hospitalization and pro bably the mortality rate. In future, various combinations of immunologic an d pharmacologic treatments may offer more permanent results in asthma thera py.