Corticosteroids are the most potent anti-inflammatory agents used to treat chronic inflammatory diseases such as asthma, rheumatoid arthritis, and inflammatory bowel disease. However, some populations of these patients are corticosteroid-insensitive (1-3), and almost of all patients with COPD show a poor response to corticosteroids (4). If the molecular mechanisms for corticosteroid insensitivity are better understood especially in COPD, this may provide insight into the mechanisms of corticosteroid action and allow a rational way to treat these patients whose disease tends to be severe. Elucidation of the cause for the relative lack of corticosteroid response in COPD may have important implications for other chronic inflammatory diseases, such as rheumatoid arthritis and inflammatory bowel disease.
No abstract is provided for this article.
Current therapy for asthma with inhaled corticosteroids and long-acting inhaled β<sub>2</sub>-agonists is highly effective, safe, and relatively inexpensive, but many patients remain poorly controlled. Most advances have been through improving these drug classes and a major developmental hurdle is to improve existing drug classes. Major unmet needs include better treatment of severe asthma (which has some similarity to chronic obstructive pulmonary disease), as well as curative therapies for mild to moderate asthma that do not result in the return of symptoms when the treatment is stopped. Several new treatments are in development, but many are specific, targeting a single mediator or receptor, and are unlikely to have a major clinical impact, although they may be effective in specific asthma phenotypes (endotypes). Drugs with more widespread effects, such as kinase inhibitors, may be more effective but have a greater risk of side effects so inhaled delivery may be needed. Several new treatments target the underlying allergic/immune process and would treat concomitant allergic diseases. Improved immunotherapy approaches have the potential for disease modification, although prospects for a cure are currently remote.
