Beta-2-agonists continue to find a dominant role in all the current guidelines on the management of chronic persistent bronchial asthma. However, the safety of the drugs remains doubtful. Thus, there is a case for review of the “Step up-Step down” approach in the management of chronic persistent bronchial asthma. Based on the currently available experimental and clinical data on bronchial asthma, the authors are of the opinion that chronic persistent bronchial asthma is best managed by a modified “Step I-Step II” approach.
National Asthma Education and Prevention Programme: Expert Panel Report III: Guidelines for diagnosis and management of asthma. Available from URL: www.nhlbi.nih.gov/guidelines/asthma/asthgdln.html.
Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Available from URL: http://www.ginasthma.com.
Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma; The Asthma Insights and Reality in Europe study. Eur Respir J 2000;16:1-6.
Lia CK, De Guia TS, Kim YY, Kuo SH, Mukhopadhyay A, Soriano JB, et al. Asthma control in Asia-Pacific region: The Asthma Insights and Reality in Asia-Pacific study. J Allergy Clin Immunology 2003;111:262-8.
Asthma control in Latin America: The Asthma Insights and Reality in Latin America study. Pan Am J Pub Health 2005;117:191-7.
Speizer FE, Doll R, Heaf P. Observations on recent increase in mortality from asthma. Br Med J 1968;1:335-9.
Cates CJ, Cates MJ, Lasserson TJ. Regular treatment with formoterol for chronic asthma: serious adverse events. Cochrane Database Syst Rev 2008;(4):CD006923.
Cates CJ, Cates MJ. Regular treatment with salmeterol for chronic asthma: serious adverse events. Cochrane Database Syst Rev 2008;(3):CD006363.
Data base on internet: The Addition of LABA to ICS in Asthma: Safety concerns regarding LABA. Available from URL: http://www.fda.gov/ohrms/dockets/ac/cder08. html#PulmonaryAllergy
Selroos O, Pietinalho A, Lofroos AB, Riska H. Effect of early V/s late intervention with ICS in asthma. Chest 1995;108:1228-34.
Pauwels RA, Löfdahl CG, Postma DS, Tattersfield AE, O'Byrne P, Barnes PJ, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma: Formoterol and Corticosteroids Establishing Therapy (FACET). N Engl J Med 1997;337:1405-11.
Lacronique J, Renon D, Georges D, Henry AM, Marsac J. High dose beclomethasone: oral steroid sparing effect in severe asthmatic patients. Eur Respir J 1991;4:807-12.
Woolcock A, Lundback B, Ringdal N, Jacques LA. Comparison of addition of salmeterol to inhaled steroids with doubling of the dose of inhaled steroids. Am J Respir Crit Care Med 1996;153:1481-8.
Bhagat R, Kalra S, Swystun VA, Cockcroft DW. Rapid onset of tolerance to the bronchoprotective action of salmeterol. Chest 1995;108:1235-9.
Humbert M, Andersson TL, Buhl R. Budesonide/formoterol for maintenance and reliever therapy in the management of moderate to severe asthma. Allergy 2008;63:1567-80.
Tukiainen H, Antti T, Reijo M, Tuija P, Thore S, Hannu P, et al. Comparison of high and low dose of the inhaled steroid, budesonide, as an initial treatment in newly detected asthma. Respir Med 2000;94:678-83.
Agertoft L, Pedersen S. Importance of the inhalation device on the effect of budesonide. Arch Dis Child 1993; 69:130-3.
Panina-Bordignon P, Mazzeo D, Lucia PD, D'Ambrosio D, Lang R, Fabbri L, et al. Beta2-agonists prevent Th1 development by selective inhibition of interleukin 12. J Clin Invest 1997;100:1513-9.
Agarwal SK, Marshall GD Jr. Beta-adrenergic modulation of human type-1/type-2 cytokine balance. J Allergy Clin Immunol 2000;105:91-8.
McGraw DW, Elwing JM, Fogel KM, Wang WC, Glinka CB, Mihlbachler KA, et al. Crosstalk between Gi and Gq/Gs pathways in airway smooth muscle regulates bronchial contractility and relaxation. J Clin Invest 2007;117:1391-8.
Callaerts-Vegh Z, Evans KL, Dudekula N, Cuba D, Knoll BJ, Callaerts PF, et al. Effects of acute and chronic administration of beta-adrenoceptor ligands on airway function in a murine model of asthma. Proc Natl Acad Sci USA 2004;101:4948-53.
Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, et al. Development of asthma control test: a survey for assessing asthma control and allergy. J Allergy Clin Immunol 2004;113:59-65.