Combination therapy of bronchial asthma

wFor treatment of moderate and severe persistent asthma the National Heart Lung Blood Institute (NHLBI) Guidelines offer the alternative of moderately , high doses of inhaled corticosteroids alone or a lower dose of inhaled co rticosteroids combined with along-acting bronchodilator. Three classes of d rugs qualify for the combination with inhaled corticosteroids. They are lon g-acting beta -agonists, leukotriene receptor antagonists, and sustained-re lease theophylline. Each class of drug has been shown, when combined with i nhaled corticosteroids, to provide equal or better asthma control than a hi gher dose of inhaled corticosteroids alone, Direct comparisons indicate tha t, of the three classes, the long-acting beta -agonists are the most effect ive. Furthermore, initial concerns regarding their masking airway inflammat ion appear to be unfounded, because it-hen combined with inhaled corticoste roids, the long-acting beta -agonists further decrease both the frequency a nd the severity of asthma exacerbations and appear to have some modulating effect on airway inflammation.