Asthma pathogenesis and new drugs for treatment - BMJ State of the Art Review

Asthma affects more than 300 million people worldwide. Of these, 10-15% have severe asthma, which is refractory to commonly available drugs. New drugs are needed because those that are currently available cannot control symptoms and exacerbations in all patients and can cause adverse reactions.

In the past 10 years, advances in asthma genetics, airway biology, and immune cell signaling have led to the development of small molecule therapeutics and biologic agents.

Several new classes of asthma drugs have been evaluated in randomized controlled trials:

- ultra long acting beta agonists
- modulators of the interleukin 4 (IL-4), IL-5, IL-13, and IL-17 pathways

Other new drug classes remain in earlier phases of development:

- dissociated corticosteroids
- CXC chemokine receptor 2 antagonists
- toll-like receptor 9 agonists
- and tyrosine kinase inhibitors

Despite some preliminary efficacy data, there is insufficient evidence to make strong recommendations about the use of these newer agents. Future research will focus on:

- clinical efficacy of the biologic agents
- effect of newer agents on severe asthma in pediatric patients
- biology of non-eosinophilic and corticosteroid resistant asthma


Asthma: pathogenesis and novel drugs for treatment. BMJ 2014; 349 doi: (Published 24 November 2014)
Cite this as: BMJ 2014;349:g5517

Image source: Lungs, Wikipedia, public domain.

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