The natural history of asthma and early intervention

Abstract

The understanding of the natural history of asthma has changed significantly during the last 4 decades, with the view that asthma is a disease of chronic inflammation and varying degrees of severity replacing that of it being a disease of reversible airway obstruction. Treatment has progressed in accordance with the growing knowledge about the pathophysiologic mechanisms of asthma. Nevertheless, much remains unknown, especially about how to treat asthma effectively. Pharmacogenetics, an emerging field in which the knowledge of the genetic basis of a disease is applied to its treatment, may ultimately lead investigators to define many unanswered questions about asthma therapy. Asthma occurs early in childhood, but the ideal time for intervention and the most effective treatment strategy are yet unknown for young patients. The lack of response to a therapy may indicate the course of the disease as much as a lack of treatment efficacy. It may be that including such variables as airway hyperresponsiveness in treatment goals will not only become routine but will result in improved long-term asthma treatment as well. The progress in defining asthma and targeting treatment toward specific pathophysiologic mechanisms should lead to better-defined optimal strategies for treating asthma in children.