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New federal guidelines on asthma treatment emphasize using steroid drugs to calm inflammation and halt the asthma process at the beginning.
In 1997, U.S. asthma doctors gained access to a new category of drugs that affect an inflammatory mechanism involving molecules called leukotrienes. Two so-called leukotriene inhibitors have recently been approved, and several more are close to approval (see "Zileuton" in the bibliography).
At first, the new drugs will be used when existing anti-inflammatories don't work, says Marcus Cohen, an allergist in Madison, Wis. "We have to see where they fit in; we don't know yet what population they'll best affect." In the future, he says, other inflammatory mechanisms that have already been identified will also become targets for drug therapy.
Furthermore, a series of experimental drugs are about to enter clinical trials. These drugs also exploit a new understanding of how the inflammation actually begins. Two drug companies are looking at antibodies -- think of them as neutralizing agents -- to interleukin-5, a messenger molecule in the inflammatory process. Tests with animals have shown that the antibodies prevent interleukin-5 from activating eosinophils -- immune cells that play a major role in inflammation. Clinical trials are imminent: (see "New Clues " in the bibliography).
Breathing lessons
But better drugs and better patient advice are not enough -- patients obviously need access to them. Part of the problem is cost. Inner-city asthmatics who have poor access to health care tend to rely on emergency rooms where the necessary follow-up is problematic at best. In other cases, patients don't want to fix what doesn't seem broke: They don't see a reason to take preventative medicine on days when they have no symptoms, not understanding that inhaled steroids are a long-term treatment for the inflammation that causes most asthma.
Norman Edelman, of the American Lung Association, sees the issue of patient education as "both a problem and an opportunity. Asthma is an illness where the active cooperation by the patient is critically important -- it leads to better control. You send the patient home with instructions on what to watch for, how to change medicines, about the triggers, how to deal with school, work and home environments. It's a complicated illness, and it requires a lot of patient know-how and activism."
We've cooked up a bibliography if you want to know more.
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