Asthma update: Part II. Medical management.

Abstract

The National Asthma Education and Prevention Program recently updated its guidelines for the management of asthma. An evidence-based approach was used to examine several key issues regarding appropriate medical therapy for patients with asthma. The updated guidelines have clarified these issues and should alter the way physicians prescribe asthma medications. Chronic inhaled corticosteroid use is safe in adults and children, and inhaled corticosteroids are recommended as first-line therapy in adults and children with persistent asthma, even if the disease is mild. Other medications, such as cromolyn, theophylline, and leukotriene modifiers, now are considered alternative treatments and should have a more limited role in the management of persistent asthma. The addition of a long-acting beta2 agonist to an inhaled corticosteroid is superior to all other combinations as well as to higher dosages of inhaled corticosteroids alone. Combination therapy with an inhaled corticosteroid and a long-acting beta2 agonist is the preferred treatment for adults and children with moderate to severe asthma. Antibiotic therapy offers no additional benefit in patients with asthma exacerbations.