Controlling Asthma

During an acute asthma episode, outflow obstruction leads to a prolonged expiratory phase. Typical findings are dyspnea, expiratory wheezing, tachypnea, tachycardia, and coughing. Pulmonary function tests provide the most useful objective measure of the extent of airflow obstruction.

According to the NAEPP, asthma management should focus on anti-inflammatory therapy. Treatment should strive to prevent symptoms, maintain near-normal pulmonary function tests, maintain normal activity levels, decrease asthma exacerbations, and provide a simple therapeutic regimen with minimal side effects. Treatment regimens are based upon asthma severity, which is classified using pretreatment clinical features, including number of days per month with symptoms, number of nights per month with symptoms, PEFR or FEV1, and PEFR variability.

Inhaled corticosteroids are the most effective agents for long-term control and are agents of choice for all patients who progress to persistent asthma. Different potencies, durations of activity, delivery mechanisms and dosing schedules are available. The NAEPP has provided a comparison of inhaled corticosteroid dosing based on topical potencies.

A chronic disease involving airway inflammation and bronchial hyperreactivity, asthma causes narrowing of the airways. It is now estimated that 15-17 million Americans have asthma. A better understanding of the pathogenesis of asthma has helped change management strategies.

The drug mometasone is currently marketed under the trade names Nasonex, a nasal spray for hayfever, and Elocon, a cream for psoriasis and rashes. Two recent studies reported that an inhalable form of mometasone appears to alleviate symptoms and improve respiratory function in patients with mild to moderate asthma. In the May 2000 issue of the Journal of Allergy and Clinical Immunology, Dr.