Therapeutic targets for persistent airway inflammation in refractory asthma.

The management of refractory asthma remains a compelling clinical problem that contributes significantly to the morbidity of patients as well as posing a financial burden to the health system. Treatment failure in this group of patients is associated with continued airway inflammation and dampening of the inflammatory cascade is the focus of much research in this area. Continued airway inflammation has been associated with higher patient morbidity and is being increasingly measured using markers of systemic and local inflammation in order to target therapy more effectively. This review focuses on the published evidence for both established and novel treatments in refractory asthma that act to control this pathological inflammatory process. No clear treatment yet exists to control this process and further research into inhibiting newly elucidated inflammatory pathways or new drugs more effectively or accurate targeting existing pathways are discussed along with the clinical evidence and the relative merits of each treatment.