A brief history of inhaled asthma therapy over the last fifty years.

This year is the 50th anniversary of the introduction into clinical use of the first modern inhaler for the management of asthma--the pressurised metered-dose inhaler (pMDI). The pMDI was initially used for the administration of the non-selective beta-agonists adrenaline and isoprenaline. However, the epidemic of asthma deaths which occurred in the 1960s led to these drugs being superseded by the selective short-acting beta-agonist salbutamol, and the first inhaled corticosteroid (ICS) beclomethasone. At the same time, sodium cromoglycate was introduced, to be administered via the first dry-powder inhaler--the Spinhaler--but owing to its relatively weak anti-inflammatory action its use is now very limited. Over the last 10 years, the long-acting beta-agonists (LABAs) have become an important add-on therapy for the management of asthma, and they are now often used with ICS in a single ICS/LABA combination inhaler.

From khellin to sodium cromoglycate--a tribute to the work of Dr. R. E. C. Altounyan (1922-1987).

Sodium cromoglycate, which was launched in 1968 by the British company Fisons for the treatment of allergies and asthma, was an absolute novelty in chemical, pharmacological as well as therapeutic respects. The khellin derivative meanwhile did not owe its discovery to the usual strategies for finding drugs. On the contrary, the protective effect of the substance was discovered in a self trial through systematic antigen-induced provocation tests of the medicinal doctor and allergic Roger Ernest Collingwood Altounyan (1922-1987). The only subsequently formed hypothesis of a mast cell stabilising effect of Sodium cromoglcycate did not prove to be valid for the search for similar or more effective substances. A further development of this drug class could not take place because of the lack of suitable pharmacological models.

Cromolyn sodium.

Cromolyn sodium is a valuable agent in the pharmacologic management of asthma. In addition to its established effects of inhibiting mediator release, it now appears that it is a useful drug for diminishing the effects of reflex-mediated asthma, nonspecific bronchial hyperreactivity, and diurnal swings of bronchial lability. Because of these unique prophylactic properties, the availability of a nebulized aqueous solution delivery system and recent clinical reports showing that its efficacy is comparable to theophylline, cromolyn sodium should be reconsidered as a first-line antiasthmatic drug in the United States.