Is nedocromil sodium effective treatment for asthma?

In the past decade, the Lreaune nt of usLhma has changed. This evolution occurred with the realization that prevention of regular asthma symptoms is preferable to treatme nt of asthmatic symptoms when they develop. Thi s unders tanding is reflected in the consensus reports on asthma management , which have rece ntly been publi shed in several countries ll-41 . These reports agree that the main aim of management is to keep asthmatic patients functioning as c lose to normal. f()r as muc h of the rime, as possible. With this in mind, the currently available drugs to treat asthma, for practical purposes, fall into two classes: those which are most useful to treat symptoms when they develop (such as P 2 -agonists or theophylline), and those which are most useful in preventing regular sympLOms and exaccrbat ions of asthma from occ uring (suc h as inhaled corticos te roids or cromoglycate). Whilst this division is somewhat artificial, (for example, inhaled P2-agonists are very useful for preventing exerc iseinduced bronc hoconsLriction) . the distinction between these c lasses of drugs IHL~ practical importance, as inhal ed corticosteroids or c rorn-oglycate arc now recomme nded as the most appropriate regular maintenance treatment for asthmatic patients witb anything o ther than infrequent symptoms 1-4. A recent addition to the physicians therapeutic armament for asthma treatment is nedocromil sodium, which was originally developed as an agent which would inhibit the release of mediators from inflammatory cells present in the airways of all (even mild, stable) asthmatics. The drug was developed as an extension of cromolyn, which was thought at the time to have similar pharmacological properties. It was hoped that nedocromil would have significant therapeutic advantages, but would retain the low side-effect profile of cromolyn. Nedocromil has been extensively studied in asthma, and the results of all known published and unpublished, placebo-controlled, double-blind, randomized clinical trials have been incorporated into a metaanalysis by EowARDS and STEVENS 5. These authors are associated with the company which has developed and marketed nedocromil and, thereby, have access to all available clinical trials, including unpublished data,