| Summary: | Asthma is a disease of chronic airway inflammation that is characterized clinically by bronchial hyper-responsiveness and airflow limitation. Chronic inflammation, coupled with ongoing repair of airways damaged by the persistent inflammatory process in asthma, results in permanent structural and functional airway changes (remodeling) that can lead to irreversible airflow obstruction. Current guidelines emphasize treatment of the underlying inflammatory process in asthma and recommend early, long-term anti-inflammatory treatment to diminish or prevent the irreversible component of airflow obstruction. Furthermore, they recognize that inhaled corticosteroids are the most effective anti-inflammatory agents available for the treatment of asthma. Patient adherence to prescribed inhaled corticosteroid medication is associated with decreased airway inflammation, improved pulmonary function and symptom control. Moreover, marked declines in morbidity and mortality due to asthma have been attributed to appropriate use of inhaled corticosteroids.
Strict patient adherence with prescribed anti-inflammatory medication is crucial for obtaining optimal therapeutic benefit for patients with asthma. Despite the proven effectiveness of inhaled corticosteroids, patient adherence to prescribed therapy is often low, resulting in increased patient morbidity. Complex dosing regimens contribute greatly to patient non-adherence. Thus, new once-daily regimens of inhaled corticosteroid treatment have been introduced as means to improve patient adherence and provide optimal therapeutic benefit. In the present review, the complex inflammatory and remodeling processes in asthma and their contributions to the clinical manifestations of the disease will be discussed. Currently available, once-daily inhaled corticosteroid treatment options and the advantages of these therapeutic options in the treatment of persistent asthma also will be discussed.
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