Inhaled Corticosteroids in the Management of Adult Asthma

The basic condition underlying bronchial asthma is a chronic airway inflammation that involves inflammatory cells and cells constituting the respiratory tract. Repeated inflammation elicits airway remodeling, leading to severer and more intractable asthma. Airway inflammation causes airway hyperresponsive- ness, which results in air flow limitation. There is no marked difference in the status of airway inflammation according to whether the condition is atopic or non-atopic or whether the patient is an adult or a child. The goal of treatment of asthma is to control and resolve airway inflammation. Inhaled corticosteroids represent safe, effective anti-inflammatory therapy and occupy a central role in the long-term management of asthma. The main elements in the application of inhaled cortico- steroids include an understanding of the importance of choosing a dose commen- surate with the severity of the condition, use of the step-down technique, and early intervention of therapy. Because it is not possible to control all cases of asthma with inhaled corticosteroids alone, it is important to appropriately combine long-acting 2 agonists, slow sustained theophylline, and leukotriene antagonists.