Λεξικό .. Symptom relievers of asthma

Symptom relievers of asthma, Ανακοφιστικά συμπτωμάτων άσθματος. .Bronchodilators such as ™2-adrenergic agonists, theophylline and muscarinic antagonists are effective both in the relief of asthmatic symptoms and prophylatically, prior to allergen exposure or exercise. Their mechanism of action is likely to involve bronchodilation or alteration of bronchomotor tone. These agents do not appear to reverse airway hyperresponsiveness and it is therefore unlikely that their long-term use will alter the course of the disease. Current interest in the search for drugs capable of improving prognosis in asthma has focused on anti-inflammatory agents[1].

.International guidelines recommend the use of rapid-onset inhaled beta(2)-agonists alone for symptom relief in all asthmatic patients. However, recent clinical trials have shown that the "as-required," or PRN, use of inhaled combinations of a corticosteroid and a rapid-onset beta(2)-agonist provides clinical advantages over the traditional PRN inhaled rapid-onset beta(2)-agonists alone in patients with different degrees of asthma severity. Asthma symptoms are associated not only with bronchoconstriction but also with increased airway inflammation.

Inhaled beta(2)-agonists have a rapid onset of bronchodilator action that is mainly mediated by a relaxing effect on airway smooth muscle. Inhaled corticosteroids also have rapid clinical effects that can suppress lower airway inflammation, and there is a rapid synergistic potentiation of the antiinflammatory effect of corticosteroids and of the bronchodilatory action of beta(2)-agonists when the two drugs are given simultaneously.

On the basis of this emerging evidence, Papi A, et al (2009) propose that the current rescue use of rapid-onset inhaled beta(2)-agonists alone should now be replaced by an inhaled rapid-acting beta(2)-agonist combined with a corticosteroid as preferred PRN strategy. They conclude with a call for clinical trials aimed to test the superiority of this approach in all degrees of asthma severity in a real-world setting in addition to any of the regular treatments recommended by international guidelines. In the future it might even be possible to control asthma entirely with PRN combination inhalers without maintenance therapy, at least in patients with less severe disease.

References

1. Schultze-Werminghaus, G.: Symptom relievers. In: Current concenpts of therapy. Symposium 10. In XIV Congress of EAACI, Berlin (West), September 22, 1989.

2. Papi A, Caramori G, Adcock IM, Barnes PJ. Rescue treatment in asthma. More than as-needed bronchodilation. Chest. 2009 Jun;135(6):1628-33