Current drug therapies: relievers and preventers.

Abstract

What we know: The different wheezing phenotypes in early childhood may influence the response to therapy. beta-Agonists are effective in acute asthma from the first year of life and anticholinergics have been shown to provide additional benefit from at least 18 months of age. Non-steroidal preventer medications provide some benefit in early childhood asthma, but response is variable and dependent on severity. Inhaled corticosteroids are the most effective preventer medication in children with persistent asthma, but have not been shown to be effective in children with episodic viral wheeze. There is no convincing evidence to suggest that inhaled corticosteroids influence long-term outcome in childhood asthma. What we need to know: Can we distinguish different wheezing phenotypes at presentation (using clinical features or other markers of airway inflammation or airway hyperresponsiveness) in order to target therapy? What are the relative benefits of reliever and preventer medications in treating different wheezing phenotypes, and do all wheezing phenotypes require treatment? What is the dose-response curve for inhaled corticosteroids in infants and young children with asthma? Are infants and young children more susceptible than older children to growth suppression or other side effects from inhaled corticosteroids? Can early treatment with inhaled corticosteroids or non-steroidal medications influence long-term outcome in terms of asthma development and/or loss of lung function?