Unconventional approaches to drug therapy in severe asthma.
Asthma is now considered as an inflammatory disease. A subset of severe asthmatic patients requires large doses of daily systemic steroids to achieve some control of the inflammation of the airways. To minimize the daily absorption of glucocorticoids, a number of medicaments have been studied for the last three decades. Methotrexate, dapsone, hydroxychloroquine, ciclosporine A, gold salts, intravenous gammaglobulins, ketotifen, triacetyloleandomycin, all demonstrated some positive effects in a small number of studies. However, our impression is that most "steroid-sparing" medications are either poorly effective in large series and/or have intolerable side effects in these chronically ill patients; many are very expensive. A revised, adjusted therapeutic strategy, using currently recommended anti-asthmatic drugs, making a major use of inhaled topical corticosteroids, should limit the number of "cortico-dependent" asthmatic patients.
Ruhl
R
R
Department of Internal Medicine, University of California Davis School of Medicine 95616.
Halpern
G M
GM
Gershwin
M E
ME
D000962:Antimalarials / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001310:Auranofin / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D003622:Dapsone / Q000627:therapeutic use; D004341:Drug Evaluation; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007665:Ketotifen / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D014217:Troleandomycin / Q000627:therapeutic use
D000962:Antimalarials; D016756:Immunoglobulins, Intravenous; D001310:Auranofin; D016572:Cyclosporine; D003622:Dapsone; D014217:Troleandomycin; D007665:Ketotifen; D008727:Methotrexate