Pharmacologic therapy for bronchial asthma.

Many drugs with which to treat reversible obstructive airway disease are available. Beta-adrenergic aerosols are the first line of defense; these are followed, when necessary, by either timed-release theophylline or oral beta-adrenergics. Often, a combination of these drugs must be used to achieve effective relief of symptoms. Once-daily theophylline preparations can be extremely effective in patients who need regular medication and in whom gastrointestinal upset or compliance is a problem. In patients who have frequent setbacks, occasional courses of tapered doses of steroid are necessary. When oral steroids are necessary regularly, the physician should consider using an aerosol corticosteroid, cromolyn sodium, or both. These drugs can be used daily with relative safety. However, only a small amount (ie, no more than 12%) of an inhaled medication reaches the lungs. In selected patients, regular doses of cromolyn sodium are used for prophylaxis and may preclude the need for theophylline or oral beta-adrenergics, which can have deleterious effects in adults and children. Cromolyn sodium is most effective if used before exercise or exposure to animals. Research is continuing on more effective and longer-acting beta-adrenergic aerosols and oral preparations.