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Panminerva Medica 2005 June;47(2):109-22

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Current treatment options for asthma in adults

Canham E. M. 1, Martin R. J. 2

1 Department of Medicine National Jewish Medical and Research Center University of Colorado Health Sciences Center Denver, CO, USA 2 Pulmonary Division Department of Medicine National Jewish Medical and Research Center University of Colorado Health Sciences Center Denver, CO, USA


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Asthma is a common disorder with an increasing prevalence in the developed world. It is a serious health problem affecting health care costs, lost productivity, and death. Unfortunately, uncontrolled asthma is common and often unrecognized by physicians; of equal concern, uncontrolled asthma is accepted by asthmatic patients as they are uneducated as to what to expect from asthma therapy. Many learn to live with the limitations of daily activity and to overuse their rescue inhalers and yet when asked by their physicians, “How’s your asthma?” the answer is “okay”. The pursuit of more revealing questions regarding frequency in the use of rescue medications, nocturnal symptoms, activity limitations, and compliance with controller medications may be then overlooked. To achieve the goal of normal life on as few medications as possible will start with a well-educated patient. Understanding intermittent from persistent asthma and then tailoring the best regimen for each patient is imperative. The treatment options and the advances in the understanding of the pathophysiology of asthma in the past 3 decades have been remarkable. There are increasing resources for both physicians and patients available to facilitate a better understanding of asthma management and the several treatment options. Currently established guidelines are an excellent starting point for initiating therapy for intermittent and mild, moderate, and severe persistent asthma. The short-acting β-2 agonists are first-line therapy for intermittent asthma, exercise-induced asthma, and acute exacerbations. Long-acting β-2 agonists, cromolyn and nedocromil, and leukotriene modifiers may also be used for exercise. Systemic corticosteroids may be needed for acute exacerbations. The treatment of choice for persistent asthma is ICS and, depending on the severity, add-on therapy with long-acting β-2 agonists, theophylline, and leukotriene modifiers are next. Lastly, omalizumab, anti-IgE therapy, will make an important place for its use in certain persistent moderate and severe asthma. This will be particularly true if the cost of the medication is reduced in the future. Asthma control, morbidity, and mortality will improve with a careful and comprehensive medical regimen using the current multiple treatment options.

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