Clinical pharmacology of asthma. Implications for treatment.

The past 10 years have seen three important changes in the philosophy of managing asthma. First, histological studies using fibreoptic bronchoscopy have led to the recognition that asthma is an inflammatory condition of the bronchial mucosa and is not simply caused by smooth muscle spasm. Secondly, there has been some disenchantment with the long term use of regular beta 2-adrenergic agonists as these agents do not appear to control bronchial inflammation and have been associated with deaths from asthma. Thirdly, there has been a general shift away from physician-centred management towards patient-oriented management plans. These three separate strands have led to the development of regional and international consensus documents that emphasise the use of regular anti-inflammatory treatment to control bronchial inflammation and reduce symptoms. With the emphasis on finding the minimum amount of treatment, several traditional anti-asthma medications have been downgraded in importance. The introduction of self-management plans is to be welcomed, but it is important that these new strategies for treating asthma are properly evaluated so that the benefits they confer can be ascertained and maximised.