Future Directions in Asthma Therapy

Is a Cure Possible?

¹ From the Department of Pulmonary Medicine, University of Chicago

Asthma correctly is characterized as a syndrome rather than a disease, because a single causative mechanism has not yet been defined. This lack of definition makes the search for a cure extremely complex. Until a common pathogenetic link is identified, the possibility of a cure is remote. The precise nature of the inflammatory response in asthma has not been defined, and current concepts of the pathogenesis of asthma represent, to some extent, a reductionistic approach to a process that has been seen variously as an allergic reaction, autonomic hyperresponsiveness, or both. Additional evidence of the polygenomic nature of the disease and the inability to define a specific pathogenetic process linked to a final common pathway suggest that gene therapies probably will not be feasible, at least for the near future. As expected, most approaches now being developed are directed toward improved therapies, and optimal treatment may obviate the need to develop complex therapies effecting a cure. Under any circumstance, the notion of a cure will have to await a more comprehensive understanding of the syndrome known as human asthma. This article is intended to provide provocative insights into the reasons why a cure remains elusive.

Key Words: asthma • asthma cure • asthma gene • asthma mortality • bronchoconstriction • eosinophil • leukotriene • leukotriene receptor antagonist