Concerns regarding the current use of β-agonists in the therapy of asthma

Asthma has been defined in many ways; clinically it represents diffuse airways obstruction which is reversible either spontaneously or with treatment. Early concepts of reversibility involved the treatment of bronchospasm with inhaled bronchodilators (1). However, we now understand the inflammatory nature of asthma and our long-term treatment is directed to reducing the inflammatory change in the airways (2). In epidemiological terms the success (or failure) of current modalities of treatment has been measured in terms of morbidity and mortality from the condition. Morbidity data are likely to be of more significance (in terms of volume) than mortality, since mortality rates are relatively low (3). However, there was an epidemic of asthma deaths in the United Kingdom in the 1960s (4). Death rates fell rapidly, however, there was a further alarming increase in asthma deaths in New Zealand from the late 1970s to the mid-1980s (5). Furthermore, in the period between 1962 and 1990, there was an increase in the number of hospital admissions for all age groups in the United Kingdom (3) and in the United States over the same period (3). The question arose, therefore, as to why, in the face of ever-increasing sales of anti-asthma medications, increased and improved therapy failed to halt these increases. Although sales of anti-asthma drugs have increased enormously (3) there have been in fact no new classes of medication marketed since the introduction of inhaled corticosteroids in the early 1970s. This further begs the question as to whether available drugs, which apparently failed to reduce the increasing morbidity and mortality, might in fact *Author to whom all correspondence and reprint requests should be addressed.