LONG-TERM TREATMENT

Fundamental: A life-threatening short-term course or progressive devel opment of severe respiratory failure is a real risk in many cases of a sthma if adapted longterm treatment is not initiated. Corticosteroids: Essential for long-term therapy, corticosteroids reduce endothelial p ermeability to inflammatory cells and reduce expression of adhesion mo lecules by inhibiting the synthesis of bronchoconstrictor mediators, i mproving mucociliary clearance and reducing mucus secretion. Other tre atments: Cromones are anti-inflammatory drugs which aci on mast cells. beta 2-mimetic drugs act on beta-receptors in muscle cells and stimul ate cyclic AMP; Theophylline, a second-line therapy has a complex mech anism of action. Antibiotics may be useful in patients who also develo p sinusitis. Objectives: The goal is to minimize chronic symptomatolog y, limit acute flare-ups, reduce the dependency on beta 2-mimetics, el iminate restrictions on physical activities, reach a variation of peak circadian expiratory flow under 20%, and minimal side effects. The ba sis of treatment were published in the 1991 consensus statement. Patie nt care: One must be constantly aware of the patient's anxiety, compli ance to treatment and triggering circumstances, recognizing and elimin ating allergenic agents.