Combination therapy of bronchial asthma.

For treatment of moderate and severe persistent asthma the National Heart Lung Blood Institute (NHLBI) Guidelines offer the alternative of moderately high doses of inhaled corticosteroids alone or a lower dose of inhaled corticosteroids combined with a long-acting bronchodilator. Three classes of drugs qualify for the combination with inhaled corticosteroids. They are long-acting beta-agonists, leukotriene receptor antagonists, and sustained-release theophylline. Each class of drug has been shown, when combined with inhaled corticosteroids, to provide equal or better asthma control than a higher dose of inhaled corticosteroids alone. Direct comparisons indicate that, of the three classes, the long-acting beta-agonists are the most effective. Furthermore, initial concerns regarding their masking airway inflammation appear to be unfounded, because when combined with inhaled corticosteroids, the long-acting beta-agonists further decrease both the frequency and the severity of asthma exacerbations and appear to have some modulating effect on airway inflammation.