Other pharmacotherapy

A small proportion of patients with severe asthma can only be controlled by oral corticosteroids. To avoid the serious side-effects of this drug, alternative pharmacotherapy has been investigated. Immunosuppressants such as methotrexate and cyclosporin A have been shown to have steroid-sparing effects in asthma but their use is associated with a high prevalence of serious side-effects. The efficacy of oral gold and nedocromil sodium seems to be limited. The steroid-sparing effect of other drugs such as intravenous immunoglobulin, troleandomycin, azathioprine, dapsone, hydroxychloroquine and colchicine still needs to be confirmed in placebo-controlled trials. Promising new medications such as leukotriene antagonists, anticytokines, antiadhesion molecules and anti-immunoglobulin E should be investigated in the near future as alternatives to systemic glucocorticoid therapy.