Clinical aspects of anti-inflammatory therapy in asthma.

Anti-inflammatory therapy is now considered first-line treatment for mild to moderate asthma. Corticosteroids remain the most potent anti-inflammatory therapy available (although their mode of action is not clearly understood), and recent investigations suggest that earlier institution of anti-inflammatory therapy may be more beneficial than delayed therapy in newly diagnosed asthmatic patients. Inhaled corticosteroids have far fewer adverse effects than their oral counterparts; however, their risks must be carefully considered before use in mild asthma. These drugs can cause alterations in the hypothalamic-pituitary-adrenal axis, alter bone metabolism, and suppress growth in children. The potential long-term risk of these alterations remains the topic of much debate.