Management of Asthma

Advances in the knowledge of clinical pharmacology and pulmonary physiology have significantly improved the management of asthma in children and adolescents. Acute episodes of asthma can be treated with oral bronchodilators if the episodes are mild, but inhaled sympathomimetic drugs are more effective and may have fewer side effects. Effective therapy for status asthmaticus consists of intravenous aminophylline and corticosteroids and aerosolized sympathomimetic drugs. Theophylline, in a dose that maintains serum concentrations between 10 and 20 µg/ml, or cromolyn is the drug of choice for managing asthma when symptoms are continuous or recur frequently. Theophylline appears to be more convenient to use than inhaled cromolyn sodium, after the proper dose is established. However, cromolyn has no risk of overdosage and does not require the measurement of serum concentrations essential for theophylline efficacy and safety. β-Adrenergic agents are useful adjuncts or alternatives to therapy with theophylline or cromolyn. Treatment by short courses of corticosteroids may be needed at intervals for patients with chronic or labile asthma. Continuous use of corticosteroids will be required for the relatively few patients whose asthma cannot be controlled with other medications. Alternate-day prednisone or inhaled beclomethasone dipropionate offer two alternatives for continuous therapy with corticosteroids which are relatively free from adverse effects of chronic steroid administration. Immunotherapy for inhaled pollens, house dust, or molds may be useful in selected patients whose allergy is clearly exacerbating to their asthma.