For and against: Should steroids be the first line treatment for asthma? • For • Against

doi:10.1136/bmj.320.7226.47

BMJ 2000;320:47-49 ( 1 January )

Education and debate

For and against

Should steroids be the first line treatment for asthma?

For

Against

Should steroids be the first line treatment for asthma?

The first 150 words of the full text of this article appear below.

Step one of the current British asthma guidelines recommends that inhaled short acting $beta$ ₂ agonists should be used as required.Some clinicians, including George Strube, a general practitionerfrom Crawley, believe that this step is unnecessary and that steroidsshould be introduced earlier. Michael Rudolph, a consultant physicianfrom Ealing Hospital, defends theguidelines.

George Strube, general practitioner.

33 Goffs Park Road, Crawley, West Sussex RH11 8AX

GStrube@aol.com

Evidence for the inflammatory basis of asthma comes from bronchial biopsies, which show inflammation of the mucosa even inpatients with mild intermittent asthma.¹ Mucosal oedema andexcess mucus production cause reduction in the lumen and obstructionto airflow. Bronchospasm occurs as the natural "foreign body"response to irritation caused by inflammation, the bronchi becomehyperactive and the airflow is further reduced. Persistent inflammationmay lead to structural changes in the airways, with reductionin lung function and irreversible airways obstruction.²

Steroids and $beta$ agonists

Steroids are the most effective anti-inflammatory drugs available. They reduce mucosal oedema and . . . [Full text of this article]

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Rapid Responses:

Read all Rapid Responses

Why use a sledgehammer to crack a nut!: Cathy Jackson
bmj.com, 1 Jan 2000 [Full text]
agree with the British gudelines for step one bronchial asthma treatment: Ivan Rodriguez
bmj.com, 2 Jan 2000 [Full text]
Don't forget the difficulties in children: John Furness
bmj.com, 2 Jan 2000 [Full text]
A Probable Solution: Ching-Chee Chan
bmj.com, 14 Jan 2000 [Full text]