The changing faces of asthma.

Abstract

Over the last 20 years, the understanding of the pathogenesis of asthma has changed dramatically. Asthma is now seen as a disease of chronic airway inflammation. Consequently, the paradigm of management has expanded from "as-needed bronchodilators" to include maintenance therapy with antiinflammatory medications and action plans. Health care professionals are assessing medications as potential disease-modifying drugs. To do this, they must understand the natural history of asthma and identify the markers of the disease that reflect long-term outcomes. This article reviews the way in which the concept of asthma has changed, the impact of this new knowledge on the basis of medication selection, and the options for evaluating the effect of medications on long-term outcomes. Reevaluating information will continue to expand our horizon of methods to improve asthma management.