Asthma therapy. Advantages and limitations of various approaches

The physician who understands the various physiologic mechanisms that result in bronchospasm can choose the appropriate management approach. Recommended initial outpatient treatment of sporadic asthma consists of administration of an inhaled beta 2 agent, followed as necessary by a systemic beta 2 agent, a long-acting theophylline preparation, cromolyn, and inhaled ipratropium. Chronic steroid therapy should be used only after a trial of combination therapy with the foregoing drugs, and the daily dose of steroids should be minimized by use of a beclomethasone inhaler. Treatment of acute attacks depends on their chronicity and severity and on the medications the patient has already taken.