LTRAs, IgE blockers, and anti-IL-5 are other antiinflammatory agents that are either currently used (LTRAs, IgE blockers) or in clinical development (anti-IL-5) for the treatment of asthma. As these were not specifically discussed, readers are directed to the literature for further information about the effects of these agents on inflamma-tion.
Spirometry is the reference tool for the diagnosis of asthma and is widely applied in the evaluation of airway hyperreactivity as well as the response to therapeutic intervention. Routine pulmonary function testing has been recommended as part of the assessment and monitoring of acute asthma, as physicians tend to underestimate the degree of airway obstruction, particularly on initial assessment. Spirometry can be performed in children as young as 6 years old. Here
Airway hyperresponsiveness can also be measured by inhalational challenge testing with methacholine or histamine. However, a study of clinical and therapeutic aspects of allergic asthma in 115 adolescents showed that pulmonary function and skin allergy tests had never been performed in 14% of patients, and 42% received no therapy at all. Only 15% of patients with persistent asthma received a stable treatment. Such data highlight the need for improved asthma management. Classification of asthma severity is discussed more extensively in the article by Graham.
Workshop participants were asked to discuss a number of questions relating to this presentation, including the following:
• Should inflammation be treated in a patient labeled with intermittent disease?
• What, in your opinion, is the best marker for inflammation?
• How would you envisage applying a reliable surrogate marker in clinical practice?
• Outline the appropriate role for each of the following in your treatment algorithm: ICS monotherapy, combination therapy, LABA, short-acting (P-agonist, LTRA.
• Where do you perceive there is an issue with the overuse of rescue medication and the underuse of controllers?
• Where do you perceive there is an issue with the overuse of fixed combination inhalers?
• To what degree is airway remodeling a consideration in your management plan?