ABSTRACT
Development of new treatments for childhood asthma poses particular
problems in view of safety concerns and the difficulty of accurately measuring clinical outcomes. There are several novel drugs in development for
the management of asthma, but these are always studied initially in adults,
and studies in children generally follow when the drug is in advanced clini-
cal development. This chapter reviews some of the new drugs in develop-
ment for asthma, some of which are currently in clinical trials for asthma
in adults. A few drugs that are improvements in existing classes of drugs,
such as corticosteroids, are testable at an earlier stage in children and
adverse effects are more predictable. Currently available therapy for asthma is highly effective and, if used
appropriately, usually has no problems in terms of adverse effects. However,
some patients (~5% of asthmatic adults and children) remain poorly controlled, despite what appears to be optimal therapy. There are also continu-
ing concerns about the safety of asthma therapy, particularly in the
treatment of childhood asthma, as this treatment has to be given over very
long periods. Compliance with inhaled therapy, particularly with inhaled corticosteroid therapy, is very poor and might be improved with oral ther-
apy (once-daily calendar pack). Yet oral therapy presents a problem of side
effects, since the drug exerts effects throughout the body, whereas asthma
is localized to the airways. This will necessitate the development of drugs
that are specific for asthma and do not have effects on other systems or on
normal physiological mechanisms (unlike b-agonists and corticosteroids). None of the currently available therapy is curative nor has it so far been
shown to alter the natural history of the disease. Perhaps it is difficult to seek a cure for asthma until more about the molecular causes is known.
