More than fifty years ago, the metered-dose inhaler was introduced as a popular way to easily carry quick-relief medication anywhere you went. Since that time, new devices, new medications, and new ways of diagnosing asthma have been introduced to the market. But other ideas are continually springing up — maybe bringing asthma symptom management to a new level. Perhaps, even finding a way to cure asthma may not be far off.

Interest is always high for creating new medications that work quickly, have fewer side effects, and are more potent, or for improving devices or delivery systems that can make current medications work even better.

There are a few other areas where the treatment of asthma could be changing as well.

Thermoplasty

A process called bronchial thermoplasty singes away smooth muscle from the bronchial airways in an effort to significantly reduce symptoms in people with moderate to severe asthma. Bronchial thermoplasty involves moving a flexible catheter with an expandable wire basket at the tip through the mouth and down the major airways that lead to the lungs.

The basket is expanded so it fits against an airway wall and sends a ten-second jolt of thermal energy to remove tissue and reduce smooth muscle. These are the muscles that contribute to asthma by contracting and narrowing the airway during an attack.

Target Genes

Research already has shown that asthma runs in families. When one or both parents have asthma, a child is more likely to develop it, too. This process is known as genetic susceptibility.

Researchers at NIEHS are taking this further to learn more about which genes make people susceptible to developing asthma when they encounter various asthma triggers in a process called gene expression profiling. They are currently screening thousands of genes at once to identify which genes are activated when a patient's airways become obstructed or inflamed.

And, science appears to be taking this in another direction as well. In Scotland, for example, researchers have identified a gene that could lead to a new treatment for asthma. This gene has been studied by teams working on diabetes, cancer, and heart disease. Their studies revealed that a certain gene makes young asthmatics two to three times more likely to have acute asthma attacks. They are hoping to replace inhaled corticosteroid therapies with tablets that are similar to those used to treat diabetes.

Remodeling

Remodeling refers to the presence of early structural changes in tissue lining the airways leading to a thicker airway wall, which creates a smaller caliber airway and makes it harder to breathe. Researchers have expressed an interest in identifying airway remodeling in young children with asthma as a way to detect and possibly prevent inflammation that may lead to reduced function later on in their lives.

Researchers have noted that cellular and biochemical changes have been detected in the airways of children with asthma and in children with respiratory symptoms or allergies even before a diagnosis of asthma has been made. Understanding the processes at work could lead in the future to new therapies and the modification of asthma's natural history, the researchers said.

New Detectors

Science may be moving beyond the traditional spirometer to detect if a child has asthma. Some medical facilities already are using devices that record and analyze exhaled nitrous oxide levels to find if asthma is present.

Under study is an “electronic nose” that uses sensors to determine if volatile organic compounds (VOCs) are present in an individual's breath. The nose, already in use in the wine and perfume industries, develops a “smell print” to compare the breath of an asthmatic with standardized readings.