Asthma in primary care patients. Challenges and controversies

Asthma varies in intensity, and patients must be treated as individuals to whom formulas do not apply. Often, the most difficult person to treat is the first-time patient whose clinical course is unknown and whose response to medications is totally untested. Although exacerbating substances should be avoided whenever possible, medication unfortunately is still needed by most asthmatic patients. At present, the choice of initial medication is subject to individual physician preference; beta 2-adrenergic agonists, cromolyn sodium (Intal), theophylline, and aerosol corticosteroids are all acceptable as first-line treatment. Addition of a second, third, or fourth medication again depends on individual response and physician choice. Patients with asthma need to be educated regarding the nature of the disease and its almost total unpredictability. Equally important is a frequent review of medications and a willingness to alter regimens as situations require.