Asthma and chronic obstructive lung disease: a pharmacologic approach

Changing concepts are emerging that should improve our ability to adequately treat asthma. This volume of Disease-a-Month reviews the triggers and the role of inflammation in asthma, and outlines the treatment of acute asthma as well as the chronic management of reversible obstructive airways disease. There is general agreement that sympathomimetics are the treatment of choice for acute severe asthma. The role of theophylline for acute symptoms has been downplayed, and the role of corticosteroids continues to be debated. However, most authorities agree that patients with severe asthma will benefit from the addition of corticosteroids to the program. For the chronic management of asthma, appreciation that inflammation is a perpetuating feature suggests that treatment should generally be directed toward the inflammation. Corticosteroid aerosols have taken on greater prominence and have been advocated as the first line of approach. New concepts regarding the role of allergy in the perpetuation of asthma and the role of immunotherapy in its amelioration also have emerged. Medications not previously thought to be beneficial are being actively investigated. They include gold, methotrexate, and even intravenous gamma globulin.