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Long-term management of reversible obstructive airways disease in adults

  • Asthma: Inflammatory Mechanisms And Clinical Management With β2-Adrenoceptor Agents
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Abstract

The goals of the long-term management of reversible obstructive airways disease (ROAD) are to find the minimum treatment that controls symptoms, allows resumption of normal life, prevents severe attack and death, and controls airflow obstruction. ROADs include asthma, chronic bronchitis, and emphysema. Although the differential diagnosis between these different entities may be difficult, they share the same possibilities of pharmacotherapy, including bronchodilator and antiinflammatory drugs.β 2-agonists administered via inhaled route produce the best bronchodilator/side effects ratio, provided that the drugs reach the bronchi. This underlines the importance of a proper inhalation technique when using a metered-dose inhaler. In patients with hand-breath coordination problems, powder inhalers or spacer devices are useful to ameliorate the therapeutic efficacy of inhaled drugs. Anticholinergic agents are usually less potent bronchodilators than inhaledβ 2 agonists in asthma, but they may have additive effects when associated withβ 2 agonists. Only a therapeutic trial with peak-flow monitoring can demonstrate the efficacy of anticholinergic drugs in individuals. Theophylline’s kinetics are characterized by a narrow therapeutic index with high inter- and intraindividual variabilities. Sodium cromoglycate and nedocromil sodium are antiallergic drugs, the efficacy of which has been demonstrated in controlled studies. Corticosteroids are the most efficient antiasthma drugs. Inhaled corticosteroid dosing should be tailored to each individual. If inhaled corticosteroid therapy is used in an oral corticosparing attempt, patients should be followed-up during several months. The management of ROAD includes the diagnostic procedures, the identification of triggers and inducers of airways obstruction, the assessment of severity of the disease, and then the treatment and education of the patient. Strategy design to achieve proper use of drugs by patients is discussed.

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  1. Institut de Recherche Thérapeutique (IRT-Eclimed), Hôpital Universitaire Cochin, 27 rue du faubourg St. Jacques, 75674, Paris Cedex, France

    Alain Lurie & Georges Strauch

  2. Département de Pneumologie, Hôpital Universitaire Cochin, Paris, France

    Alain Lurie, Fotis D. Vlastos, Daniel J. Dusser & Jean Marsac

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  1. Alain Lurie
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Lurie, A., Vlastos, F.D., Dusser, D.J. et al. Long-term management of reversible obstructive airways disease in adults. Lung 168 (Suppl 1), 154–167 (1990). https://doi.org/10.1007/BF02718128

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