REVUE FRAN~AISE D'ALLERGOLOGIE ET D'IMMUNOLOGIECLINIQUE New asthma treatments: recent advances and current objectives K.E CHUNG KEY-WORDS: Asthma - Treatment - Inhaled corticosteroids - ~2-agonists - Theophylline - Leukotriene inhibitors. MOTS-CLI~S: Asthme - Traitement - Corticost~roides inhalfis - ~2-agonistes - Th6ophylline - Inhibiteurs du Leucotri6ne. INTRODUCTION In order to understand the role of new treatments in asthma, it is necessary to review first the recent changes that have taken place and to survey the current clinical unmet needs for asthma such that particular areas of need could be specifically targeted. Over the last eight years or so since the introduction of national asthma guidelines in many countries [1-3], there has been several advances in the treatment of asthma. These advances relate to improved understanding of existing drugs such as the pharmacology and molecular mechanisms of corticosteroid actions, the positioning of the new class of long-acting ~- agonists on the basis of new studies and the introduction of a new class of drugs for asthma, the leukotriene inhibitors. The recognition that chronic inflammatory processes are present in the airways of patients with even mild asthma and that such processes may contribute to bronchial hyperresponsiveness and airway narrowing, and to remodelling of the airways has increasingly led to the use of anti-inflammatory agents as first-line treatment of asthma, leaving the use of short- acting [3-agonists for relief of breakthrough symptoms. The initial recommendation has been to use either non-steroidal ,~anti-inflammatory,, agents such as sodium cromoglycate or nedocromil sodium, particularly in pediatric asthma or low-dose inhaled corticosteroid therapy. However, experience with these agents indicates that low-dose inhaled steroid therapy is more predictably effective [4,5] and that the anti- inflammatory agent of choice is inhaled corticosteroids even at low doses. There are also doubts as to whether nedocromil sodium has anti- inflammatory effects such as reducing eosinophil infiltration in the airways submucosa [6]. By contrast, more recent studies confirm the effect of topical corticosteroid treatment in reducing the number of inflammatory cells in the airways National Heart & Lung Institute, Imperial College School of Medicine, & Royal Brompton Hospital, LONDON, (United Kingdom). Correspondence : Pr. K.E Chung, National Heart & Lung Institute, Dovehouse St, LONDON SW3 6LY, (United Kingdom). Interasma Marrakeeh' 98. CHUNG K.E - New asthma treatments: recent advances and current objectives. Rev. fr. Allergol., 1998, 38 (7S), $214-$221. © Expansion Scientifique Publications, 1998