Chronic persistent asthma: A review of medicines in the step-up approach
Date
2008
Authors
Irusen E.M.
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Abstract
The medications used in asthma have been the subject of intense study over the last three decades. We now have extensive insights into their structure, regulation, receptors and mechanisms of action. Their intersection with the complexity of asthma inflammation has also been well characterised. In parallel, good quality pharmaceutical trials have informed national guidelines and patient-centered outcomes have been explored. With this therapeutic armamentarium the practitioner should aim to achieve the goals of asthma therapy that are focused on clinical and lung function parameters. The concept of complete asthma control is the current benchmark. Airway inflammation is the fundamental problem in asthma and, logically, anti-inflammatory therapy in the form of inhaled corticosteroids is the single most important intervention. The importance of appropriate use of inhaler devices cannot be sufficiently emphasised. The clinician carefully titrates this treatment utilising additional medications for synergy and to modulate side-effects and costs. The contemporary standard of asthma care is a single inhaler with a combination of inhaled corticosteroids (ICS) and long-acting beta adrenoceptor agonists. The alternative is to add leukotriene modifiers to ICS therapy; there are special circumstances when this may be more appropriate. Poor inhaler use and concomitant allergic rhinitis are examples when supplementation with anti-leukotriene agents would be prudent. With whatever therapeutic strategy, regular education of the patient, tailoring of medication and monitoring of asthma are still crucial to ensure that the goals of asthma control are achieved and maintained in the long term.
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Keywords
beclometasone dipropionate, beta 2 adrenergic receptor stimulating agent, beta adrenergic receptor stimulating agent, bronchodilating agent, budesonide, budesonide plus formoterol, cholinergic receptor blocking agent, ciclesonide, cimetidine, corticosteroid, cromoglycate disodium, fluticasone propionate, fluticasone propionate plus salmeterol, leukotriene receptor affecting agent, leukotriene receptor blocking agent, macrolide, montelukast, nedocromil sodium, quinoline derivative, salbutamol, salmeterol, theophylline, zafirlukast, add on therapy, allergic rhinitis, antiinflammatory activity, asthma, candidiasis, cataract, clinical trial, comorbidity, Cushingoid syndrome, drug antagonism, drug dose increase, drug dose reduction, drug dose sequence, drug efficacy, drug mechanism, drug metabolism, drug receptor binding, drug safety, exercise induced asthma, gastrointestinal disease, growth disorder, heart disease, human, larynx disorder, low drug dose, neurologic disease, patient compliance, patient education, peak expiratory flow, pharyngeal candidiasis, receptor affinity, respiratory tract inflammation, review, skin bruising
Citation
South African Family Practice
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