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Maintenance therapy for obstructive lung disease. How to achieve the best response with the fewest agents.

Abstract
Asthma is now thought to be primarily an inflammatory condition with secondary bronchospasm; hence, the mainstay of maintenance therapy is an inhaled anti-inflammatory drug, either a corticosteroid (especially in adults) or a mast-cell stabilizer (especially in children). Inhaled beta agonists are reserved for acute exacerbations and systemic corticosteroids for severe refractory disease. Oral theophylline is sometimes helpful, especially for nocturnal exacerbations. Chronic bronchitis and emphysema almost always stem from cigarette smoking. Bronchospasm is the predominant cause of symptoms, and maintenance therapy with an inhaled anticholinergic (eg, ipratropium bromide [Atrovent]) is the best approach. If symptoms are not controlled, an inhaled bronchodilator should be added. An oral or inhaled corticosteroid benefits a minority of patients. Theophylline is especially helpful for chronic bronchitis and nocturnal exacerbations.
AuthorsM Jacobs
JournalPostgraduate medicine (Postgrad Med) Vol. 95 Issue 8 Pg. 87-90, 93-6, 99 (Jun 1994) ISSN: 0032-5481 [Print] UNITED STATES
PMID8202425 (Publication Type: Journal Article, Review)
Chemical References
  • Adrenal Cortex Hormones
  • Bronchodilator Agents
  • Theophylline
  • Ipratropium
Topics
  • Administration, Inhalation
  • Administration, Oral
  • Adrenal Cortex Hormones (therapeutic use)
  • Adult
  • Bronchodilator Agents (therapeutic use)
  • Child
  • Diagnosis, Differential
  • Drug Therapy, Combination
  • Exercise
  • Humans
  • Immunization
  • Ipratropium (therapeutic use)
  • Lung Diseases, Obstructive (classification, diagnosis, etiology, physiopathology, therapy)
  • Middle Aged
  • Nutritional Physiological Phenomena
  • Smoking (adverse effects, prevention & control)
  • Theophylline (therapeutic use)

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