Non-corticosteroid anti-inflammatory drugs in asthma: clinical pharmacology and recommendations for use.
Asthma is a chronic inflammatory disease of the airways. As airways inflammation plays a principal role in the pathogenesis of asthma, even in patients with mild disease, current recommendations give anti-inflammatory therapy a central position in the treatment of asthma. Although inhaled corticosteroids are the most widely used anti-inflammatory drugs in the management of patients with asthma, nonsteroidal anti-inflammatory agents may be used as a first step. Sodium cromoglycate (cromolyn sodium) and nedocromil are anti-inflammatory drugs which are effective in many patients with asthma of mild to moderate severity. Both drugs have been demonstrated to be well tolerated. Nedocromil is more potent than sodium cromoglycate, although the number of clinical studies that have compared these two drugs is small. Nedocromil may also be effective as a corticosteroid-sparing agent in the treatment of patients with asthma who require high dosages of inhaled corticosteroids. This may be important, as high dosages of inhaled corticosteroids may cause adverse effects. A novel approach to the treatment of asthma is represented by the leukotriene synthesis inhibitors and leukotriene receptor antagonists, new classes of anti-inflammatory drugs. Although the number of clinical studies with these agents is relatively small, they indicate effectiveness in the treatment of patients with mild to moderate asthma with no systemic adverse effects. Theophylline has only recently been reconsidered as a potential anti-inflammatory drug. Although serious toxicity may occur with this agent, theophylline is effective in reducing symptoms and improving lung function in patients with mild chronic asthma, even in those already treated with inhaled corticosteroids.
de Jong
J W
JW
Department of Pulmonology, University Hospital Groningen, Groningen, The Netherlands.
Postma
D S
DS