New information is changing the way practicing physicians and the Food and Drug Administration view the role of drugs in asthma treatment and prevention. Asthmatics also tend to produce thick, sticky mucus and have inflamed, damaged airways, both of which worsen the breathing restriction caused by bronchospasm. During an acute attack, asthmatics seem to have a hard time getting their breath. Actually they are struggling to push air out of over-inflated lungs through constricted airways. That understanding of asthma led to treatments aimed primarily at opening up the bronchial tubes by using drugs that cause the bronchial muscles to relax their grip on air passages.
Bronchodilators are still a mainstay of asthma therapy.
But Robert Meyer, M.D., of FDA's Center for Drug Evaluation and Research, notes that scientists' understanding of asthma has changed significantly over the last decade or so. He points out that since the early 1980s, increasing scientific evidence shows that inflammation is as much responsible for bronchospasm as anything else. The evidence Meyer refers to strongly indicates that asthma is a chronic inflammatory disease that usually develops within the first few years of life. People with chronically inflamed airways may show no outward signs of asthma until the first acute attack requires urgent medical attention, often at a hospital emergency department. They are likely to recommend the patient be seen by an asthma specialist, who can devise a combination of treatment and prevention measures aimed at avoiding or minimizing further acute asthma attacks.