WHEN TO START AND TO STOP ANTI-ASHMATIC THERAPY: A RATIONALE BEYOND GUIDELINES

Key words: Asthma, Therapy, Prevention, Guidelines

The understanding of the chronic bronchial inflammation characterizing asthma led us to a more convinced and accurate use of inhaled corticosteroids such as long lasting therapy. Although times and ways for this treatment have been defined by several guidelines proposed by the most respected World Scientific Institutions, at the moment there are no clear answers concerning “when to start and to stop anti-asthmatic therapy”. As a consequence, there is a large variability in physicians’ behaviours that certainly contributes to the frequent poor adherence of patients to this long lasting treatment. The current evidence on the inefficacy of all pharmacological treatments in modifying persistently the natural history of asthma might lead to a less aggressive pharmacological approach, with regard of length and dosages, and might also lead to a less frequent clinical and instrumental evaluation. Finally, it still needs to be proved that an early steroid therapy, started in very young ages at the beginning of ashtma, could permanently modify the course of asthma and avoid the irreversible obstructive damages of the respiratory tract (remodelling).