New concepts in chronic asthma. What is the impact on therapy?

The following management guidelines, based on changing concepts in asthma pathogenesis and treatment, outline an approach aimed at reducing asthma morbidity and mortality. Use of these guidelines may help to reduce airway hyperreactivity and result in improved care for these patients. Maintain open lines of communication between patient and physician. Promote positive patient-physician interaction. Remain alert for signs of psychological problems. Use maintenance antiinflammatory medications and bronchodilators as needed. Discuss medication requirements and possible side effects. Caution against abuse of beta agonists. Monitor drug diaries and theophylline levels to assess medication requirements and compliance with treatment. Monitor daily peak expiratory flow rates in patients prone to severe attacks of asthma. Encourage patients to report progressive symptoms or peak expiratory flow rates less than 200 liters/min. For asthma uncontrolled by bronchodilators and inhaled antiinflammatory medications, treat promptly with systemic corticosteroids.