Finding the Most Effective Treatment for Asthma
The most effective treatment for chronic asthma, overall, is a combination of a long-acting inhaled beta agonist and an inhaled corticosteroid (ICS). Currently, there is only one product available in the US—Advair (GlaxoSmithKline), which contains fluticasone and salmeterol. Symbicort (AstraZeneca) is available in other parts of the world, but has not yet been approved in the US. It has, however, been undergoing active studies and will probably become available in the fairly near future. Other products, on which studies are just beginning, will combine formoterol with ciclesonide and mometasone, but they are several years away.

5-lipoxygenase Inhibitors for Asthma Treatment
The only 5-lipoxygenase (5-LO) product currently on the market is a zilueton tablet. Originally manufactured by Abbott, it went off the market and was then purchased by Critical Therapeutics and re-launched in August 2005. This company will eventually develop a sustained release product that is dosed twice daily, but the current problem and real disadvantage of this product is that patients are required to take it four times a day. The author has prescribed it in the past, and the general feeling is that it probably is somewhat more effective than the leukotriene receptor antagonists. This product also has a certain amount of baggage because a small percentage of the people taking it develop liver enzyme elevation, so a physician needs to check a patient’s blood for liver enzymes over the first few months of therapy.When controlling the symptoms of asthma, combination therapies are clearly more effective than inhaled steroids alone, even in higher doses.The combination therapies are also more effective than the combination of inhaled steroids with other drugs, such as leukotriene receptor antagonists.

The Gaining Optimal Asthma Control Study
The Gaining Optimal Asthma Control (GOAL) study investigated whether the goals of asthma therapy, as outlined in the guidelines, could really be achieved in patients using current therapy. The results of the GOAL study were split; approximately 70% of patients achieved at least a well-controlled status with the use of the combination therapy—the percentage was approximately 10% lower with inhaled steroids alone. Clearly, that degree of asthma control is achievable in the majority of patients through the use of a combination of long-acting beta agonists and ICSs.

The flip side was that 30% of patients did not achieve a well-controlled status despite a high dose of inhaled steroids and long-acting beta agonists.This re-emphasises the point that there are asthmatics who, for a variety of reasons, are somewhat or very steroid-resistant or -insensitive, which means that other medications are needed for those patients. For the treatment of those patients, there are no good medications at present. Alternative medications are, for example, leukotriene receptor antagonists and theophylline, but they are not very effective.However, a number of drugs are currently being pursued, the main potential audience of which will be the group of patients that do not respond well to the ICSs. Examples are tumor necrosis factor (TNF) antagonists such as etanercept and the calcineurin inhibitor tacrolimus, which has been so effective in atopic dermatitis and is now being looked at in inhaled form. Daclizumab and omalizumab are monoclonal antibodies against the interleukin (IL)-2 receptor and immunoglobulin E (IgE), omalizumab being the only one that is currently approved. Several other drugs that are under investigation would largely target that same group of patients.

Asthma and Rhinitis Treatment
A number of studies have been exploring the association between asthma and rhinitis, and have suggested that one treatment can treat both conditions. There is no question that the one airway concept is true.