Anti-inflammatory drugs in asthma therapy

29 Bronchial asthma is a chronic inflammatory disease characterized by reversible airways obstruction, airways inflammation and increased airways responsiveness to a variety of stimuli. Clinical and experimental studies have shown the contribution of the airways inflammation to clinical course and severity of asthma. Anti-inflammatory drugs are therefore of major importance in the treatment of all varieties of asthma. Their long-term use is the only way to reduce bronchial hyperresponsiveness and asthma symptoms. Inhaled corticosteroids are the most effective antiinflammatory agents used for treatment of asthma. They are therefore drugs of choice in therapy of persistent asthma including its mild variety. Other drugs used in asthma management like nedocromil sodium, cromolyn sodium, leukotriene modifiers and theophylline also show, although much less, anti-inflammatory action. In vitro studies have demonstrated anti-inflammatory activity of β2-agonists, however this has not been proved by clinical trials so far. According to the GINA 2002 (Global Initiative for Asthma) expert panel report the disease treatment should be individual and matching asthma severity. To classify the asthma severity combined assessments of lung function, symptoms as well as the level of medication regimen, if the patient is already on treatment, are required [1]. The primary goal of asthma therapy is to maintain full control of the disease, which is possible to achieve in most patients. In well-managed asthma the symptoms are minimal or none at all, also at night and the patient is not limited in daily activities. Pulmonary function is normal or close to normal. There are no exacerbations of asthma and no need for emergency department visits or hospitalizations. The use of short-acting beta2-agonists for relief of acute symptoms is minimal. The last but not least goal is to provide the therapy for asthma with minimal or no side effects. Anti-asthma medications are now categorized into two general groups: long-term control medications and relief medications. The first are used daily to maintain long-term asthma control as opposed to relievers which should be used only in case of asthma symptoms exacerbation. The most effective anti-inflammatory medications for suppression of allergic inflammation and for maintenance of asthma symptoms are inhaled corticosteroids.