Alternative agents in asthma

Glucocorticosteroids are the backbone of asthma therapy and are administere d mainly by the inhaled route. Patients with "difficult" asthma are not a s ingle homogeneous group. Some are stable on high-dose steroid therapy but e xperience unacceptable side effects; others remain unstable despite receivi ng high doses of inhaled or oral steroids. Several different steroid-sparin g and alternative agents have been tried, with varying degrees of success. Some success has been achieved with conventional immunosuppressants such as methotrexate, gold, and cyclosporin A, but these agents can be justified o nly in a limited range of cases. Leukotriene receptor antagonists have prov ed a useful addition to asthma therapy and have been shown to have a modest steroid-sparing effect. Although existing range of alternative agents has not proved to be particularly effective, several new therapeutic agents hav e been developed to target specific components of the inflammatory process in asthma. These include IgE antibodies, cytokines, chemokines, and vascula r adhesion molecules. Future developments might include better forms of imm unotherapy and strategies targeting the remodeling of structural elements o f the airways.