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May 23/30, 2001

Therapeutic Options for Persistent Asthma

JAMA. 2001;285(20):2637-2639. doi:10.1001/jama.285.20.2637

During the 140 years that followed Henry Hyde Salter's first description of asthma1 as a distinct syndrome characterized by paroxysmal episodes of bronchospasm, there has been a relentless search to understand the mechanisms by which this disease affects the conducting airways. The specific airway inflammation in asthma involves mast cells, macrophages, and eosinophils orchestrated by cytokines secreted from a subset of T cells (TH2-like) and is accompanied by increased bronchial hyperresponsiveness to both direct (eg, methacholine) and indirect (eg, exercise) stimuli. These characteristics may in part explain the disordered airway function in asthma, its relationship to environmental exposures, and therapeutic responses observed with inhaled corticosteroids and β2-agonists.2,3 For both inhaled corticosteroids and β2-agonists, the last 2 decades have witnessed a progressive improvement in drug efficacy, delivery, duration of action, and therapeutic index, making twice daily inhaled therapy for asthma feasible.

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