The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Alternate Therapies for Severe Asthma

Barry J. Make, MD Wednesday, November 6, 1996

The goals of management of patients with asthma are to maximize airflow, reduce the chronic use of oral steroids, and prevent exacerbations and thus reduce the need for expensive health care resources such as emergency visits and hospitalizations. While steroids are very effective in controlling the disease in many patients, their chronic use is frequently associated with adverse effects.

The following alternate strategies will be discussed to achieve the desired outcomes in patients with severe asthma: methotrexate, leukotriene antagonists and inhaled steroids. Methotrexate is an example of an anti- inflammatory agent which has been proposed as an agent to allow reduction in oral steroid dose. While earlier investigations reported a reduction in steroid use, more recent studies have not consistently demonstrated this effect. A review of these studies provides insights into important issues in study design which will be useful in assessing the results of future investigations. Leukotriene antagonists are an exciting new therapeutic option which will be commercially available in the near future. These agents are based on new understanding of the biochemicals mechanisms of the disease. However, selecting patients who are likely to benefit from such therapy and careful assessment of outcomes are important issues. Inhaled steroids are not associated with adverse effects, and newer agents have recently become available in the United States.

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