[Asthma therapy: are bronchodilators obsolete?]

Short acting beta 2-agonists, such as salbutamol, fenoterol and terbutaline, are the most potent bronchodilating agents in the treatment of acute asthmatic attacks. In chronic asthma, however, they must be viewed as purely symptomatic treatment compared to antiinflammatory agents (inhaled corticosteroids, cromoglycate and nedocromil sodium), prophylactic agents which can also decrease airway hyperresponsiveness and thereby stabilize the disease. Modern asthma treatment are based on the present understanding of asthma pathophysiology and take into account the new therapeutic options with high dose inhaled steroids and long acting beta 2-agonists. Patients with only occasional asthma symptoms should receive inhaled short acting beta 2-agonists as needed. These agents continue to be central to the treatment of any asthmatic attack. If asthma symptoms occur more than 4-6 times a week a regular inhalative antiinflammatory regimen should be initiated (e.g. inhalative corticosteroids b.i.d.). In cases with frequent symptoms or persisting airway obstruction, regularly administered inhalative bronchodilators (beta 2-agonists, possibly long acting) should be added to high dose inhaled steroids. Treatment of severe acute asthma should always include systemic glucocorticosteroids (e.g. prednisone 30-60 mg/day). Special emphasis should be placed on self-management plans, encouraging patients to monitor and treat their disease themselves in close cooperation with the physician.