Pharmacologic management of asthma.
Obstructive airway disease from asthma needs to be distinguished from other causes, classified with regard to clinical pattern, and assessed to identify severity and precipitating factors. Intervention of acute symptoms is most effective with inhaled sympathomimetic bronchodilators backed up with short courses of high-dose oral corticosteroids for symptoms that are suboptimally responsive to bronchodilation alone, especially for those patients with a history of emergency care requirements and/or hospitalization. Maintenance therapy with scheduled daily use of inhaled beta2 agonists, cromolyn, and slow-release theophylline can be used prophylactically for patients with chronic disease. The inhaled beta2 agonists are the most effective therapeutic agents for relieving acute bronchospasm and for decreasing responsiveness of the airways to specific stimuli such as exercise; however, even the newer agents have sufficiently short duration of effect to limit efficacy for maintenance therapy. Cromolyn and slow-release theophylline are commonly used for chronic therapy; cromolyn has the merit of virtually no toxic potential but is less convenient and less likely to be effective, at least for more severe asthma, than theophylline. Corticosteroids uniquely decrease the inflammatory component of asthma, thereby decreasing or preventing airway obstruction from mucosal edema and secretions. Short courses of high-dose oral steroids without tapering provide useful and safe intervention for acute symptoms, whereas alternate-morning oral use and the new generation of topical inhaled agents provide acceptably safe alternatives for managing chronic disease not controlled with other measures. Nonpharmacological factors that require therapeutic consideration include environmental factors such as cigarette smoke and aeroallergens, and general physical conditioning. Compliance with the medical recommendations requires dealing with dysfunctional attitudes and beliefs held by the patient and/or family and the fostering of an internal locus of control by including the patient in the decision-making process.
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000628:therapy; D001337:Autonomic Agents / Q000627:therapeutic use*; D002648:Child; D004205:Cromolyn Sodium / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D013566:Sympathomimetics / Q000627:therapeutic use; D013806:Theophylline / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D001337:Autonomic Agents; D013566:Sympathomimetics; D013806:Theophylline; D004205:Cromolyn Sodium