Special Issue "Antiasthmatic Drugs"

Guest Editor
Prof. Dr. Peter J. Barnes
Department of Thoracic Medicine, National Heart and Lung Institute, Imperial College, Dovehouse St, London SW3 6LY, UK
Website: http://www1.imperial.ac.uk/medicine/people/p.j.barnes/
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Guest Editor
Prof. Dr. Paolo Montuschi
Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
E-Mail:
Interests: asthma; chronic obstructive pulmonary disease (COPD); pharmacological therapy of asthma and COPD; allergy; non-invasive monitoring of lung inflammation; exhaled breath condensate; exhaled nitric oxide; electronic nose; metabolomics

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Manuscript ID: Pharmaceuticals-Antiasthmaticd-20090518- Barnes-uk
Type of Paper: Review
Title: Antiasthmatic Drugs
Authors: Paolo Montuschi ¹ and Peter J. Barnes ²
Affiliations: ¹Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy,
²Airway Disease Section, Imperial College, School of Medicine, National Heart and Lung Institute, London, United Kingdom
Abstract: Pharmacologic treatment is the mainstay of management in most patients with asthma. The primary goals of treatment of asthma are relief of symptoms, normalization of pulmonary function, prevention of acute exacerbations, reduction of airway hyper-reactivity, and improvement of quality of life. A relevant goal in asthma control is to prevent the putative long-term consequences of airway inflammation, particularly airway remodelling. However, whether pharmacological control of airway inflammation positively influences the natural history of asthma is currently unknown partially due to the relative short duration of clinical trials. Different long-term control medications including inhaled corticosteroids, leukotriene receptor antagonists, long-acting beta-agonists, cromones, and theophylline, are regularly used for asthma control. Short-acting beta-adrenergic agonists, that can be combined with antimuscarinic drugs, are generally effective for treating acute asthma exacerbations. Pharmacotherapy of asthma is characterized by a stepwise approach based on increasing medications until asthma is controlled, and decreasing medications when possible to minimize side effects. In general, the intensity of treatment should match the severity of symptoms. As a result, patients with infrequent and mild symptoms should be treated intermittently whereas patients with persistent symptoms should receive long-term controller medications. However, the threshold for initiating inhaled corticosteroid therapy is not evidence-based and the concept that airway remodelling is evitable in patients who take these drugs regularly is not fully elucidated. Some reports have raised the question about the need for chronic controller therapy in mild persistent asthma. Regular use of inhaled corticosteroids, generally the most effective long-term controller drugs for asthma, is associated with improvements in symptoms and lung function, and with reductions in exacerbations, hospitalizations and deaths from asthma. In patients with asthma who are not adequately controlled with inhaled corticosteroids alone, add-on therapy with long-acting beta agonists or leukotriene receptor antagonists is generally preferred to increasing the dose of inhaled corticosteroids. Combination of inhaled corticosteroids and long-acting beta-adrenergic agonists is generally effective for asthma control. However, issues regarding safety of long-acting beta agonists, even in combination with inhaled corticosteroids, have been raised. A minority of patients with asthma has a severe disease that is poorly responsive to antiasthmatic drugs that are currently available. In these patients, search for new drugs for asthma is justified. The pharmacologic response to antiasthmatic drugs such as leukotriene receptor antagonists, and to a much lesser extent inhaled corticosteroids, is characterized by inter-individual variability. This might be partially explained by the heterogeneity of asthma and the different selectivity in the mechanisms of action of drugs for asthma. Identification of phenotypes of patients with asthma who are more likely to respond to different classes of antiasthmatic drugs is relevant for choosing the best therapeutic strategy in the individual patients with asthma. This special issue will present the pharmacological profile, including mechanisms of action, of the principal classes of antiasthmatic drugs, review data on their efficacy and safety, discuss controversial issues including safety of long acting beta agonists, and present the possible pharmacological strategies for asthma control.
Keywords: asthma; antiasthmatic drugs; asthma control; airway inflammation; inhaled corticosteroids; leukotriene receptor antagonists; short-acting beta agonists; long-acting beta agonists; chromones; theophylline