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Die Stellung von Cromolyn (Lomudal, Intal, Aarane) im Behandlungsplan des Bronchialasthmas

The place of cromolyn (Lomudal, Intal, Aarane) in the management of bronchial asthma

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Abstract

Cromolyn (Lomudal, Intal, Aarane) plays an important role in the modern therapy of bronchial asthma. Its combination with a betastimulator activating the cyclic AMP of the mast cells, inhibiting their degranulation and developing an antiallergic activity directly on the bronchioles, leads to an optimal antianaphylactic synergy; indeed, Cromolyn inhibits the mast cells phosphodiesterase (which inactivates the cyclic AMP) and therefore protects the mast cell against the degranulation (like the betastimulators) and prevents synergistically the release of asthma mediators.

Cromolyn has to be inhaled deeply into the airways with a Spinhaler after a betastimulator-induced bronchodilatation. If possible, the drug is to be taken before the signs and symptoms of an asthmatic attack. The mode of application most often used is long-term treatment with a dosage of 20 mg 4 times, or a spincap 4 times, per day. Frequently steroid-dependent patients can, slowly and with caution, lower the daily prednisone dose somewhat. Sudden withdrawal from Cromolyn and Prednisone must be avoided.

Cromolyn treatment of extrinsic asthma with immediate allergy type I is most successful, especially in children. Perennial asthma and asthmatic bronchitis may also respond to Cromolyn, particularly when the bronchial obstruction is partly reversible, when a moderate eosinophilia of the bronchial secretions is present, and when an exercise-induced bronchoconstriction is prevented by Cromolyn.

Zusammenfassung

Cromolyn (Lomudal, Intal, Aarane) nimmt einen wichtigen Platz in der modernen Asthmatherapie ein. Kombiniert man es mit Betastimulatoren (die die cyclische AMP der Mastzellen aktivieren, hiermit die Degranulation der Mastzelle hemmen und an den Bronchiolen direkte antiallergische Wirkungskomponenten haben), so erzielt man mit Cromolyn über die Hemmung der Phosphodiesterase (welche den Abbau der cyclischen AMP fördert) einen idealen antianaphylaktischen Synergismus: die Mastzelle wird vor der Degranulation optimal geschützt, und asthmagene Mediatoren, das Produkt der Degranulation, werden nicht oder nur in geringem Maß freigesetzt.

Cromolyn wird in Pulverform wenn irgendwie möglich vor dem Ausbruch des Anfalles mit dem Spinhaler inhaliert. In der Regel treibt man eine systematische Langzeitprophylaxe, indem man zu Beginn täglich 4mal 20 mg, also 4mal eine Kapsel — nach erfolgter Bronchospasmolyse mittels Betastimulation — tief in die Luftwege einatmet. Steroid-abhängigen Asthmatikern kann man unter Cromolyn meist die Unterhaltungsdosis Prednison langsam und vorsichtig etwas senken.

Beim Anfallsasthma mit Allergie vom Soforttyp I hat man — vor allem im Kindesalter — die größten Chancen auf Linderung der Beschwerden. Das perenniale Asthma und die chronische reversible, eosinophile Asthmabronchitis bilden zwar ebenfalls Indikationen für Cromolyn, vor allem wenn das Mittel die Patienten erwiesenermaßen vor dem Anstrengungs-induzierten Bronchospasmus zu schützen vermag, doch ist die Erfolgsquote geringer als bei der ersterwähnten Indikation.

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  1. Pneumologische Abteilung, Medizinische Universitätsklinik, Inselspital Bern, Switzerland

    M. Scherrer

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Scherrer, M. Die Stellung von Cromolyn (Lomudal, Intal, Aarane) im Behandlungsplan des Bronchialasthmas. Pneumologie 151, 1–9 (1974). https://doi.org/10.1007/BF02101139

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