A new approach to the treatment of asthma

Article Abstract:

In industrialized countries, asthma affects more than five percent of the population, yet it is not adequately diagnosed or treated. The prevalence of the condition and associated mortality rates appear to be on the rise, in contrast to many other common treatable conditions. Until recently treatment has been focused upon counteracting bronchoconstrictor mechanisms and promoting the dilation of the bronchial pathways. Drugs for this purpose generally act by opposing the contraction of airway smooth muscle and include beta-adrenergic agonists (beta blockers) and anticholinergic drugs (parasympathetic nerve blocker). More recent approaches have concentrated more upon the characteristic inflammatory response of the airways caused by asthma. The inflammation of the airways has long been associated with more severe stages of the disease. However, this symptom is characteristic of even the milder forms of asthma. Asthma has been identified as a chronic inflammatory condition and treatment with anti-inflammatory drugs is considered by the author to be the most effective therapeutic approach. For maximum benefits, anti-inflammatories should be given on a long-term basis, as they do not relieve symptoms immediately or have a fast-acting bronchodilator effect. The introduction of anti-inflammatory agents such as corticosteroids or cromolyn sodium is recommended at early stages of this condition. The author believes that corticosteroids have been underutilized in recent years due to their adverse side effects, but newly developed steroid inhalation treatments may be an effective first step in the treatment of asthma. Inhalation therapy is preferred over oral treatment because it is effective in lower dosages and therefore reduces the frequency of side effects.

Antiasthmatic agents, Anti-inflammatory drugs, Anti-inflammatory agents, Bronchodilator agents, Steroids (Drugs)

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Inhaled glucocorticoids for asthma

Article Abstract:

Inhaled glucocorticoids appear to be relatively safe and very effective in reducing the airway inflammation that often occurs in asthma. Glucocorticoids act by inhibiting the release of naturally-occurring chemicals that promote inflammation such as macrophages, T-lymphocytes and eosinophils. They may also reduce mucus production. Studies have also shown that they reduce the sensitivity of the airway to environmental irritants. Inhaled glucocorticoids appear to have fewer side effects than oral glucocorticoids. After inhalation, much of the drug is swallowed and enters the bloodstream, where it can cause systemic side effects. This can be prevented by using a spacer and rinsing the mouth after use. Localized side effects include hoarseness, thrush, cough and irritation. There is little evidence that inhaled glucocorticoids suppress cortisol production by the adrenals, inhibit bone formation, stunt growth, cause cataracts or psychiatric disorders. It also appears to be safe during pregnancy.

Corticosteroids, Adrenocortical hormones, Respiratory therapy

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Tolerance to the nonbronchodilator effects of inhaled beta2-agonists in asthma

Article Abstract:

Asthma patients may develop tolerance to the non-bronchodilator action of inhaled beta 2-agonists during long-term use. Inhaled beta 2-agonists dilate the bronchi, or the tubes that supply air to the lungs, and affect the contraction of smooth muscle in the airways of the lungs. Twelve patients with mild asthma inhaled 500 micrograms of the beta 2-agonist terbutaline or a placebo, an inactive substance, before treatment with two different bronchoconstrictors, and then before and after treatment for seven days with terbutaline or a placebo. The single dose of terbutaline decreased airway responsiveness to both bronchoconstrictors used in the study before seven days of treatment with terbutaline. After seven days of treatment with terbutaline, the single dose of terbutaline increased airway response to both bronchoconstrictors. Long-term treatment with terbutaline may affect cells of the immune system involved in contraction of muscle in the airways of the lungs.

Adrenergic beta agonists, Adrenergic beta-agonists

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