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Early treatment in asthma: How early is early?


Correspondence: Professor Tari Haahtela Division of Allergy, Skin and Allergy Hospital, Helsinki University Central Hospital, PO Box 160, 00029 HUS, Finland. Email:


In the 1990s, the definition of asthma changed as we realized that asthma is fundamentally an inflammatory disorder. It was also shown in both adults and children that treatment should be initiated with anti-inflammatory medication (preferably inhaled steroids) and delayed treatment may worsen lung function outcome. There is increasing evidence that, in both children and adults, early and effective therapy with inhaled steroids results in long-term remission in the majority of patients. In future, even intermittent asthma symptoms will be treated with inhaled steroids. The first signs of asthma should be treated effectively, even in small babies. In children with atopic dermatitis, early pharmacotherapy may prevent asthma and in children with hay fever, specific immunotherapy may reduce the asthma risk. Airway eosinophilia predisposes a patient to asthma. The benefit of early intervention in patients who show eosinophilic airway inflammation but have normal or near normal lung function has been recently demonstrated. It seems that we should treat ‘asthma even before asthma’, if the disease is defined in terms of lung function. Persistent asthma is difficult to reverse, but early stages of asthma could be more responsive to novel therapies, such as drugs modifying the pro-inflammatory cytokines or monoclonal antibodies against IgE. The emerging new methods to assess airway inflammation will cast light on the origin of asthma, as well as on the determinants of disease persistence. Along with the development of practical inflammatory markers, the doctor gets a clearer picture of the disease. This means a better understanding for the doctor and better tailored treatment for the patient and this will further improve treatment results.