Clinical Review

Fortnightly review

Modern drug treatment of chronic asthma

BMJ 1999; 318 doi: 10.1136/bmj.318.7180.380 (Published 6 February 1999)
Cite this as: BMJ 1999;318:380

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  1. Brian J Lipworth, professor of allergy and respiratory medicine (b.j.lipworth@dundee.ac.uk)
  1. Department of Clinical Pharmacology and Therapeutics, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY

    The drug treatment of asthma has remained essentially unchanged over the past three decades in terms of the use of corticosteroid, β2 agonist, and theophylline drugs. Asthma treatment has also been improved by the widespread dissemination and implementation of management guidelines emphasising the pivotal role of first line preventative, anti-inflammatory therapy. 1 2 This article provides a brief overview of modern drug treatment for chronic asthma. It does not cover the treatment of acute asthma, which is discussed in detail elsewhere.3

    Summary points

    The dose of inhaled steroid should be titrated against asthmatic symptoms, peak flow, and usage of β2 agonist drugs

    The safest dose of inhaled steroid is the lowest effective maintenance dose producing optimal long term control and quality of life

    Adding second line anti-inflammatory controller treatment such as a leukotriene antagonist or theophylline may be an alternative to monotherapy with a high dose of inhaled steroid

    If control is inadequate despite optimised anti-inflammatory treatment, it is better to add regular treatment with a long acting β2 agonist drug than a short acting one

    Methods

    I searched Medline and BIDS for articles published between 1977 and 1998, using appropriate index terms for each drug or class of drugs. I included key review articles and searched manually for relevant papers and abstracts in recent issues of mainstream journals on general, respiratory, and allergy medicine. This article was also based on personal, long standing, clinical and research interests in the management of allergy and asthma. Some aspects of this review will inevitably be based on personal opinion, particularly where the latest guidelines are already out of date—for example, with the emerging role of leukotriene antagonists.

    Fig 1

    The inflammatory cascade in asthma

    First principles of treatment

    The past decade of research has led to a greater understanding of the pathophysiology of asthma and, in particular, …

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