Day-to-day management of asthma.

Asthma remains a major cause of morbidity and an occasional cause of mortality in children despite greatly increased knowledge of its pathophysiology and newer improved medications. Management of asthma requires consideration of the two components of airway obstruction, spasm of bronchial smooth muscle and inflammation resulting in mucosal edema and mucous secretions. The pharmacologic alternatives include medications that relax bronchial smooth muscle, prevent the release of mediators that induce bronchospasm and inflammation and anti-inflammatory corticosteroids that can reverse or prevent the inflammatory component of asthma. Therapeutic decisions in asthma also require consideration of the clinical pattern of disease which can be classified as intermittent, seasonal allergic or chronic. Therapeutic strategies for the use of pharmacologic agents include intervention measures for reversal of acute symptoms and maintenance measures to prevent symptoms. While all patients need available intervention measures to reverse acute symptoms when present, only those patients with prolonged periods of symptomatology, i.e. seasonal allergic or chronic, require pharmacologic agent for maintenance therapy. When evaluation identifies environmental factors as clinically important precipitants of asthma, appropriate environmental manipulation offers a potentially useful nonpharmacologic approach to therapy. The use of injections of allergenic extracts in selected patients with appropriate inhalant allergen sensitivity offers an immunologic approach for decreasing symptoms in patients with a predominant inhalant allergic component to their disease. Success in the treatment of asthma requires careful consideration of health care delivery. Available measures, when appropriately delivered to the patients when needed, have been convincingly demonstrated to greatly decrease morbidity.