Drugs for airway disease

Abstract

Asthma is a heterogeneous disease characterized by chronic airway inflammation and variable expiratory airflow limitation. It affects 5–15% of people worldwide and has shown an increasing prevalence over the last decade. The treatment of asthma is well established in current guidelines, with the aim of achieving optimal disease control and preventing acute exacerbations using a stepwise medication approach. Drugs are commonly divided into ‘relievers’, which quickly reverse airway obstruction, and ‘controllers’, which target the underlying inflammation providing long-term control. β2-adrenoceptor agonists are the most effective therapy for preventing and treating bronchial obstruction, while inhaled corticosteroids are recommended as first-line chronic therapy for persistent asthma. Drugs such as muscarinic antagonists, anti-leukotrienes and macrolides also play a role in disease management. New personalized therapies, such as biological agents or small molecules, have become available or are under development for treatment of severe asthma, together presenting opportunities with developments in biomarkers for interventions of precision medicine.