Asthma: current controversies and emerging therapies
Mani S. Kavuru, MDAddress reprint requests to M.S.K., Department of Pulmonary and Critical Care Medicine, A90, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Lily Pien, MD
Dianne Litwin, MD
Serpil Erzurum, MD
Muzaffar Ahmad, MD
Despite advances in understanding the pathogenesis of asthma, a number of controversies regarding the optimal clinical management of asthma remain. This review of recent literature and current controversies, chosen mainly on the basis of relevance to clinical therapy, is directed toward nonspecialists caring for asthmatic patients.KEY POINTS
Recent evidence indicates asthma is mediated by airway inflammation, and maintenance therapy should include inhaled anti-inflammatory drugs. Inhaled corticosteroids are usually the first choice. However, adverse effects of long-term use are just being recognized. Optimal dosage, spacer devices, and gargling reduce these effects. Although inhaled beta agonists are essential for acute asthma management, their use in regular maintenance therapy is under reevaluation. Excessive use of beta agonists usually indicates the need for more effective anti-inflammatory therapy.
All patients should avoid allergens. A subset of asthma patients who fail to respond to treatment may benefit from immunotherapy, but there are risks. Emergency management of acute asthma should include early and frequent administration of aerosolized beta agonists and almost universal therapy with corticosteroids.