Future perspectives on asthma treatment

In recent years, the importance of inflammation has become apparent in the pathogenesis of asthma. Furthermore, much information has been forthcoming on the interactions between the immune and neurogenic systems in mediating the pathophysiologic manifestations of asthma. With this new insight has come an ever expanding list of therapeutic options aimed at controlling the underlying process of asthmatic inflammation. Strategies aimed at shifting the milieu of cytokines and helper T lymphocytes to one which inhibits allergic inflammation appear promising as newer therapeutic options. Indeed, studies in animal models have shown the potential therapeutic benefits of DNA and directed cytokine therapies aimed at the earliest stages of the allergic inflammatory cascade. Inhibitors of the production or effects of IgE have demonstrated efficacy in both animal models and human asthma. Strategies designed to inhibit the migration of inflammatory cells into the airways are also being examined. Specific antagonists to inflammatory mediators, such as LTD4, clearly have proved beneficial in subsets of patients. The expanded utility of thee antagonists in selected patients is undergoing clinical evaluation. Finally, selected phosphodiesterase antagonists and modulators of neurogenic pathways also hold promise. For example, early studies with muscarinic receptor subtype blockers have demonstrated clinical efficacy in both COPD and asthma. This review focuses on these newer therapeutic strategies for asthma outlining both the rationale for their development, effects in vivo, and potential for treating patients with asthma.