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Anti-Inflammatory Drugs in Asthma.

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Anti-Inflammatory Drugs in Asthma. Sampson AP, Church MK, eds. (Pp 288, hardback). Switzerland: Birkhauser, 1999. ISBN 3 7643 5873 4

This is one of a series of publications under the collective heading “Progress in Inflammation Research” to which some of the European heavyweights in asthma research have contributed chapters. All the asthma drugs are included with the notable exception of the anticholinergic agents, although I found the title a little misleading as the in vivo anti-inflammatory effects of some of the drugs discussed remains contentious. However, from the opening chapter it becomes apparent that investigations into the pathophysiology of, and the effects of treatment on, asthma have played an important part in defining the inflammatory mechanisms. The “commonly” used asthma medications are discussed initially with Peter Barnes giving an erudite synopsis of the anti-inflammatory effects of corticosteroids. The next two chapters deal with the putative anti-inflammatory effects of phosphodiesterase inhibitors and β2 adrenoceptor agonists, although the chapter on phosphodiesterase inhibitors concentrated on the different isoenzymes and thus was heavy going with little discussion of their anti-inflammatory effects and no concluding summary. Despite theophylline being available for at least 40 years, I was struck by the paucity of clinical data available regarding its efficacy and in vivo anti-inflammatory effect (if at all). This is presumably because it is not profitable for pharmaceutical companies to investigate the drug further. The mast cell stabilisers are considered next, and the last third of the book deals with leukotriene antagonists and discusses other novel potential anti-inflammatory agents including anti-IgE agents, cytokines and adhesion molecule antagonists.

Several of the chapters are interesting and well written with well laid out tables and graphs, although some have several annoying typographical errors. The book does provide a good summary of the anti-inflammatory effects of present and potential future asthma medications and would act as a good reference source for departments or individuals with an interest in this field.—JB