Pulmonary Pharmacology & Therapeutics (1998) 11, 317–318Article No. pu990175

PULMONARYPHARMACOLOGY& THERAPEUTICS

Preface

A fundamental point is when to start anti-inflammatory treatment. It seems that the early in-troduction of inhaled corticosteroid in asthma maypositively influence anticipated changes in pulmonary

This issue of Pulmonary Pharmacology & Therapeuticspresents the Proceedings of a workshop entitled ‘Phar-macological Control of Airways in Health andDiseases’, which was held in Capri, Italy, duringOctober 1998. These proceedings include a collection function over time both in adults and children. It is

unknown whether similar outcomes would be notedof topical and interesting papers discussing crucialfactors about the treatment of obstructive airways using other compounds which also exhibit anti-

inflammatory effects in vitro and in vivo. Althoughdisease.Considering that airway obstruction and in- these positive effects are noteworthy, they are balanced

by concerns related to the potential for long-termflammation are the peculiar characteristics of bothasthma and chronic obstructive pulmonary disease side-effects of various therapeutic interventions. In

particular, the main concern with inhaled cortico-(COPD), it is not a surprise that both bronchodilatorsand antiinflammatory agents must be considered the steroid treatment is the potential for dose related

systemic effects. Studies which showed that addingcornerstone in the treatment of these pathologicalconditions. While new classes of drugs are entering a long acting b2-agonist to a low dose of inhaled

corticosteroid drug produced comparable control tointo clinical practice and will join existing treatmentin routine clinical use, the prospects for improved monotherapy with a higher dose of inhaled cortico-

steroid. The mechanism by which this interactiontherapy for COPD are less rosy than for asthma.As for bronchodilator therapy, the current opinion occurs remains to be elucidated, but may involve a

protective effect of corticosteroids on dysfunctionalis that b2-agonists are more active than anticholinergicdrugs in the symptomatic treatment of bronchial b-adrenergic receptor expression and function. New

fixed dose combinations of fluticasone and salmeterolasthma, whereas recommended doses of anti-cholinergic agents are equally effective and/or more will soon become available in Europe. The value of

corticosteroids in the management of clinically stableefficacious than short-acting, but not long-acting b2-agonists in COPD. The choice of regular or in- COPD has yet to be established. In particular, there

is very little evidence to date on the effect of inhaledtermittent bronchodilator treatment is another im-portant question. Several researchers’ opinion is that steroids in this disease. Only the publications of

EUROSCOP and ISOLDE studies will define the roleregular inhalation of a short-acting b2-agonist is as-sociated with deterioration of asthma control in the of long-term treatment with inhaled corticosteroids

on lung function decline in smokers with COPD.majority of subjects. However, no signs of tachy-phylaxis have been reported after the use of long- The evaluation of leukotriene-modifying drugs in

the treatment of asthma is currently hampered by aacting b2-agonists. Moreover, the bronchodilatoryeffect seems to be fairly stable after regular treatment. relative paucity of published clinical experience with

these drugs. They may be useful for patients withTherefore, the trend is likely to favour longer-actingagents, both b-agonists and anticholinergics, using mild to moderate asthma. However, until more clinical

studies are done, the precise positioning of this class ofpropellants containing no chlorofluorocarbons. Theweight of clinical evidence would, at present, seem to compound in the armamentarium of asthma therapy

remains to be demonstrated. In any case, we mustsupport the use of combined bronchodilator therapy.However, the impact of long-acting agents on com- stress than an increase in the number of eosinophils

is seen in the sputum of asthmatic patients, whereasbinations is still unclear. Regular assessment of thepatient’s physiologic status will determine the clinical in COPD the number of neutrophils is increased,

indicating that the two inflammatory conditions areusefulness of these drugs. Therefore, carefully de-signed studies are required to define their role and, different, as likely are their corresponding responses

to cysteinyl antileukotrienes. On the contrary, it ispossibly, to develop a new treatment algorithm forCOPD. possible that LTB4 antagonists might be useful in the

treatment of COPD.Inhaled corticosteroids are the most potentantiinflammatory agents for treating asthma. Clarifying differences in response to all agents which

1094–5539/98/050317+02 $30.00/0 1998 Academic Press317

318 Preface

are available for the treatment of obstructive airways GlaxoWellcome Italia, in particular Drs Antonio Pa-disease is an essential part of tailoring a management mariello and Renato Testi, reflecting their continuingplan to each individual patient, considering that phys- commitment to the respiratory community.icians must always choose a drug that is highly effic-

Mario Cazzolaacious, safe and inexpensive. In any case, although theFondazione S Maugeri,treatment of obstructive airways disease is now far

IRCCS,more advanced than it was several years ago, the bestCentro Medico di Riabilitazione,is yet to come.Obviously, futuremanagement will likely

Unita di Farmacologia Clinica e Centrofocus on new drugs, improvements to existing drugdi Farmacologia Respiratoria,formulations, or more efficient delivery devices.

The workshop and this issue are sponsored by Veruno (NO), Italy