Newer and alternative non-steroidal treatments for asthmatic inflammation

Although most patients with asthma can be effectively managed with minimal toxicity using available treatments, some patients are relatively resistant to treatment or are at risk for adverse effects from treatment, such as hi gh-dose systemic corticosteroids. In considering new or alternative therape utic candidates for asthma treatment, those possessing anti-inflammatory pr operties are of greatest interest because inflammation is recognized as hav ing central importance in the pathogenesis of persistent asthma. Of non-ste roidal agents that have well-established positions in asthma treatment, ned ocromil and cromolyn possess significant anti-inflammatory effects, and the ophylline and beta agonists possess some al anti-inflammatory effects of po tential relevance to asthma. In addition, there are a number of newer or al ternative therapies that have theorized or demonstrated anti-inflammatory e ffects in asthma, including leukotriene modifier agents, anti-IgE, gold, ne bulized lidocaine, cyclosporine, intravenous immunoglobulin, methotrexate, hydroxychloroquine, dapsone, and troleandomycin. This review summarizes ava ilable data about these agents for asthma, focusing on their putative or pr oven mechanisms of action, evidence for clinical benefit, and their potenti al role as corticosteroid sparing agents, and principal toxicities. The rev iew also discusses factors that confound assessment of the clinical benefit of agents in asthma, including variability in the natural history of asthm a, heterogeneity of airway inflammation, and varying responses to treatment in different subsets of asthmatics.