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Conrad Notes IndexspacerAllergy, Asthma, and Immunology Index

Conrad Notes
a timely medical meeting newsletter
S. J. Szefler, MD, National Jewish Center for Immunology and Respiratory Medicine, Denver, Colo, melded published literature with personal research in addressing the status of asthma care. Asthma, a chronic inflammatory disorder of the airways, results in bronchoconstriction, edema, mucus plugging, and collagen formation. Specialists recommend allergen avoidance and taking controller drugs (antiinflammatories and bronchoprotectors) and reliever drugs (short-acting bronchodilators). Other measures are needed to improve asthma management.
Treating airway inflammation Asthma is a chronic inflammatory disease. Inhaled glucocorticoids, the cornerstone for treating asthma, directly access lung tissue. This route reduces the adverse effects experienced with systemic dosing.

When should physicians initiate treatment with inhaled glucocorticoids? Szefler advocates early intervention in persistent wheezing children. This recommendation stems from two observations: (1) severe adult asthma often begins in early childhood and (2) inhaled glucocorticoids may delay collagen formation in the bronchi or prevent irreversible changes. Concern for the delayed growth seen in children treated with systemic glucocorticoids prompted a 5-year comparative safety and efficacy study with budesonide and nedocromil, two antiinflammatory drugs used in treating asthma.

Inhaled glucocorticoids Current access to several marketed glucocorticoid aerosols requires further evaluation to assure optimal prescribing. Szefler finds the term potency misused in describing the clinical activity of different glucocorticoids. This misuse often leads some managed care groups to substitute one aerosol for another on the basis of cost alone. Comparative studies would help. Symptom control and spirometry may differentiate the aerosols in terms of dose, frequency of administration, and duration of treatment. Such studies are especially important in view of the newer powder formulations capable of increasing pulmonary deposition of the drug.
Improving asthma management Our inability to control the increasing prevalence of asthma, especially in children, prompts Szefler to suggest several measures for improving asthma management:

  • Help the physician and patient stay up-to-date on asthma pathophysiology and new medications.

  • Reduce airway inflammation by improved enviromental control and pharmacotherapy.

  • Simplify treatment regimens by identifying primary controllers (antiinflammatory and bronchoprotective drugs) and relievers (short-acting bronchodilators).

  • Equate persistent symptoms with persistent inflammation.

  • Find a niche for new medications such as the leukotriene inhibitors and antagonists.

Eugene A. Conrad

Presented at the Annual Meeting of the American College of Allergy, Asthma and Immunology on 8 November 1996
CONRAD NOTES, © January 1997 All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078 / posted 8-Feb-1997

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