NEW ASPECTS OF THE TREATMENT OF BRONCHIAL -ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

The expansion of our knowledge regarding the pathogenesis of asthma ha s now made clear that it is an inflammatory disease. Although the trea tment of bronchospasm associated with asthma is essential, it is impor tant to consider the inflammatory aspect of the disease. The first the rapeutic approach is to control environmental hazards (allergen, air p ollution, tobacco smoke). It should always be remembered that patient education is of critical importance. Patients with only occasional ast hma symptoms (2-4 times a week) should receive inhaled short-acting be ta-2 agonists as needed. Treatment with inhaled corticosteroids is ins tituted in all asthmatics except the mildest cases. Long-acting beta-2 agonists are an additional therapy for patients with unsatisfactory s ymptom control despite an optimal dose of inhaled steroids, particular ly when there are nocturnal symptoms. Chronic obstructive pulmonary di sease is defined as a disease state characterized by the presence of a irflow obstruction due to chronic bronchitis or emphysema. Although th e airflow obstruction is generally progressive, comprehensive therapeu tic management benefits all patients including those with severe disea se: stopping smoking, vaccination against influenza and pneumococcus, pharmacologic therapy. The judicious use of bronchodilators increases airflow and reduces dyspnea. Ipratropium and beta-2 agonists are equal ly efficacious and may work synergistically. The use of corticosteroid s is controversial. Thus a closely monitored steroid trial of therapy should be considered in patients who have continuing symptoms or sever e airflow limitation despite maximal therapy with other agents. Broad spectrum antibiotics are beneficial in severe exacerbations.