[Asthma - historical development, current status and perspectives]

Asthma is not a new disease. It is one of the most common chronic disorders affecting approximately 4-5 % of adults and more than 10 % of children in Germany. This turns asthma into one of the most prevalent chronic disorders. Over the last century ideas about its pathogenesis have changed many times. While around one hundred years ago asthma was often considered a neurotic disease, changes in airway smooth muscle, mast cell accumulation and activation or specific mediators such as platelet-activating factor have since been incriminated in its pathogenesis. Eosinophils, cytokines and T-lymphocytes were favourites some time later. Nowadays, - and this is unlikely to be the end of the story - asthma is considered as a complex disorder of the adaptive immune system. Therapeutic approaches have changed dramatically, too. While until about 30 years ago asthma was still considered a Smooth muscle disorder, recurrent attacks of asthma which required frequent, mostly nocturnal interventions, status asthmaticus, or the necessity of mechanical, invasive ventilation have markedly decreased. In view of the asthma epidemic in recent years, this development suggests that current treatments are at least partially effective. In spite of this patients with asthma are often only moderately well controlled with considerable morbidity from the disease as well as its treatment. Thus, despite recent advances in diagnosis and treatment, asthma is still not a trivial disease and future attempts at improving the care of those affected are warranted. The developments of the past 100 years as well as a careful look into the future are presented in this review.