Early treatment of asthma.

The early treatment of asthma was not greatly studied before the 1990s. Subjects included in intervention trials have usually had persistent asthma with a long duration of symptoms. Only a few studies have been done on early intervention. It has also become obvious that eosinophilic airway inflammation is common and does not always significantly affect lung function. If patients do not fulfill the functional criteria for asthma, they may not receive specific diagnosis and effective treatment. I have suggested the term "asthma-like inflammation" to describe the disorder of such patients. Bronchial obstruction and increased bronchial responsiveness are outcomes of the inflammatory process, and it may be argued that detection of eosinophilic inflammation is always late at the time asthma is diagnosed. The diagnosis of asthma is often severely delayed, a fact which influences the prognosis and efficacy of therapeutic interventions. The benefits of early treatment of symptomatic asthma have been shown, and several international guidelines recommend anti-inflammatory medication, preferably with inhaled steroids as first-line treatment to gain control of the disease as fast as possible. Very few studies, however, have addressed the long-term influence of various therapeutic approaches. Usually, the beneficial effects gradually disappear when treatment is withdrawn. There is no convincing evidence that any of the current pharmacologic therapies can change the natural course of asthma. Nevertheless, inhaled steroids seem to have a disease-modifying effect if started early enough, and there is a consensus that steroids abolish symptoms, improve lung function, and decrease the need for hospitalization and probably the mortality rate. In future, various combinations of immunologic and pharmacologic treatments may offer more permanent results in asthma therapy.