Early intervention of therapy in asthma

Abstract

In addition to the acute manifestations of asthma, researchers now understand that asthma is a chronic inflammatory disease of the airways. Knowing the critical time to intervene in asthma is of utmost importance to clinicians and patients alike. This article reviews recent evidence that early intervention improves long-term outcomes in asthma. The recent published literature demonstrates that early in the course of asthma, changes in structure occur, and that even in very young children, measurable abnormalities of lung function have already occurred. Large studies of inhaled corticosteroids given early in the progression of asthma show, at best, only modest effects on long-term lung function. Though a study on inhaled corticosteroids in very young children is ongoing, there is little evidence to suggest that any other commonly used medications have important effects on underlying lung function. Recent studies have also highlighted the lack of clear understanding of the relation between inflammation and remodeling, and parallel the disappointing results from studies of inhaled corticosteroids on lung function. Current anti-inflammatory medications have modest effects on preventing loss of lung function in asthma. Although inhaled corticosteroids are highly efficacious in controlling the overt clinical manifestations of the disease, their effects on lung function are small. The standard paradigm of inflammation leading to remodeling and remodeling to loss of lung function may be overly simplistic. In the future, novel pharmacologic targets and careful timing of treatments must occur to intervene effectively with remodeling and/or decline in lung function in asthma.