Asthma is a chronic inflammatory disease of the lower respiratory tract which is triggered by exposure to allergens or other airway irritants, and is commonly encountered in otolaryngologic practice. This three-part review is designed to assist otolaryngologists in effectively managing their asthmatic patients. In Part I, current information on the pathophysiology and increasing prevalence of asthma, its clinical variability, the assessment of asthma severity and methods for diagnosis of asthma were summarized. Part 11 discusses a tripartite strategy for asthma management, based on environmental controls, the use of anti-inflammatory therapies and patient education. In addition, pharmacologic treatments which are not primarily anti-inflammatory are reviewed in detail. The uses, effectiveness, side effects and suitability for drug combination therapy for mucolytic, anticholinergic, antihistamine, theophylline and beta agonist drugs are compared, and the disadvantages of beta antagonists are summarized. Part III concludes with an overview of antiinflammatory therapies for asthma control.
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References
1.
ShefferA.L.Guidelines for the diagnosis and management of asthma. J Allergy Clin Immunol1991; 88: 425–533.
2.
Fernandez-CaldasE., FoxR.W.Environmental control of indoor air pollution. Med Clin N Am1992; 76: 935–52.
3.
ThienF.C.K., LeungR.C.C., CzarnyD.Indoor allergens and IgE-mediated respiratory illness. Immunol Allergy Clin N Am1994; 14: 567–90.
CallR.S., WardG., JacksonS.Investigating severe and fatal asthma. J Allergy Clin Immunol1994; 94: 1065–72.
6.
ShefferA.L.Management of the adult asthma patient. Allergy Proc1995; 16: 1–4.
7.
ClarkN.M., FeldmanC.H., EvansD.The impact of health education on frequency and cost of health care use by low income children with asthma. J Allergy Clin Immunol1986; 78: 108–15.
8.
KrahnM.Issues in the cost-effectiveness of asthma education. Chest1994; 106: 264S–269S.
9.
LiJ.T.C.Do peak flow meters lead to better asthma control?J Respir Dis1995; 16: 381–98.
10.
BrittonJ.R., PavordI.D., RichardsK.A.Dietary antioxidant vitamin intake and lung function in the general population. Am J Respir Crit Care Med1995; 151: 1383–87.
11.
BrittonJ., PavordI., RichardsK.Dietary magnesium, lung function, wheezing and airway hyperreactivity in a random adult population sample. Lancet1994; 344: 357–62.
12.
PatersonJ.W., LulichK.M., GoldieR.G.Pharmacology of asthma treatment: An overview. Med J Australia1995; 162: 42–3.
13.
FukudaT.Immunosuppressive agents and asthma. Clin Rev Allergy1994; 12: 95–108.
14.
KnappH.R.Reduced allergen-induced nasal congestion and leucotriene synthesis with an orally active 5-lipoxygenase inhibitor. N Engl J Med1990; 323: 1745–8.
15.
DonnellyA.L., GlassM., MinkwitzM.C.The leukotriene D4-receptor antagonist ICI 204,219 relieves symptoms of acute seasonal allergic rhinitis. Am J Respir Crit Care Med1995; 151: 1734–9.
16.
TaniguchiY., TamuraG., HonmaM.The effect of an oral leucotriene antagonist, ONO-1078 on allergen-induced immediate bronchoconstriction in asthmatic subjects. J Allergy Clin Immunol1993; 92: 507–12.
17.
MillmanM., GrundonW.Use of acetylcysteine in bronchial asthma and emphysema. J Asthma Research1969; 6: 199–209.
18.
KisilF.T., SehonA.H., HollingerH.Z.In vitro and in vivo inactivation of reagins with mercaptans. Clin Allergy1971; 1: 387–97.
19.
BoneR.C.Managing mucus secretions in patients with asthma or COPD. J Resp Dis1990; 11: 240–59.
20.
BerdyG.J.Angle closure glaucoma precipitated by aerosolized atropine. Arch Int Med1991; 151: 1658–60.
21.
CorbridgeT.C., HallJ.B.The assessment and management of adults with status asthmaticus. Am J Respir Crit Care Med1995; 151: 1296–1316.
22.
WoodC.C., FiremanP., GrossmanJ.Product characteristics and pharmacokinetics of intranasal ipratropium bromide. J Allergy Clin Immunol1995; 95: 1111–16.
23.
HolgateS.T.Antihistamines in the treatment of asthma. Clin Rev Allergy1994; 12: 65–78.
24.
WeintraubM.Letter to the editor. N Engl J Med1994; 331: 1019.
25.
MarzanattiM., MonopoliA., TrampusM.Effects of nonsedating histamine H1-antagonists on EEG activity and behavior in the cat. Pharmacol Biochem Behav1989; 32: 861–6.
Cua-LimF.An evaluation of the efficacy and safety of loratadine syrup vs. astemizole syrup in perennial allergic rhinitis. Immunol Allergy Pract1991; 13: 47–53.
29.
KnightA.Clinical evaluation of the efficacy and safety of noberastine, a new H1 antagonist, in seasonal allergic rhinitis. J Allergy Clin Immunol1991; 88: 926–34.
30.
SmolenskyM.H., ReinbergA., LabrecqueG.Twenty-four hour pattern in symptom intensity of viral and allergic rhinitis: Treatment implications. J Allergy Clin Immunol1995; 95: 1084–96.
31.
HolgateS.T., FinnertyJ.P.Antihistamines in asthma. J Allergy Clin Immunol1989; 83: 537–47.
32.
RaffertyP., HolgateS.T.Histamine and its antagonists in asthma. J Allergy Clin Immunol1989; 84: 144–51.
33.
JinquanT., ReimertC.M., DeleuranB.Cetirizine inhibits the in vitro and ex vivo chemotactic response of T lymphocytes and monocytes. J Allergy Clin Immunol1995; 95: 979–86.
34.
SpectorS.L., NicodemusC.F., CorrenJ.Comparison of the bronchodilatory effects of cetirazine, albuterol and both together versus placebo in patients with mild-to-moderate asthma. J Allergy Clin Immunol1995; 96: 174–81.
35.
ZechnichA.D., HedgesJ.R., Eiselt-ProcteauD.Possible interactions with terfenadine and astemizole. West J Med1994; 160: 321–5.
36.
DarrowW.R.Important diagnostic information. Letter to U.S. physicians from Schering-Plough Research Institute, 2000 Galloping Hill Rd., Kenilworth, NJ 07033, July 1, 1994.
37.
BrandesL.J., WarringtonR.C., RandiJ.A.Enhanced cancer growth in mice administered daily human-equivalent doses of some H1-antihistamines: Predictive in vitro correlates. J Natl Cancer Inst1994; 86: 770–5.
38.
WeedD.L.Between science and technology: The case of antihistamines and cancer. J Natl Cancer Inst1994; 86: 740–1.
39.
AbramowiczM.Acrivastine/pseudoephedrine (Semprex-D) for seasonal allergic rhinitis. Med Letter1994; 36: 78–80.
40.
GirardJ.P., Sommacal-SchopfD., BigliardiP.Double-blind comparison of astemizole, terfenadine and placebo in hay fever with special regard to onset of action. J Int Med Res1985; 13: 102–8.
SalomonssonP., GottbergL., HeilbornH.Efficacy of an oral antihistamine, astemizole, as compared to a nasal steroid spray in hay fever. Allergy1988; 43: 214–18.
43.
RohrA.S.Non-sedating antihistamines: A selective review of terfenadine, astemizole, cetirizine and loratadine. Immunol Allergy Pract1989; 11: 334–7.
44.
BarenholtzH.A., McLeodD.C.Loratadine: A nonsedating antihistamine with once-daily dosing. DICP, Annals Pharmacol1989; 23: 445–50.
JuhlinL., ArendtC.Treatment of chronic urticaria with cetirizine dihydrochloride a non-sedating antihistamine. Br J Dermatol1988; 119: 67–72.
47.
ReidJ.J.Double-blind trial of ketotifen in childhood chronic cough and wheeze. Immunol Allergy Practice1989; 11: 143–9.
48.
BannerA.S.Theophylline: Should we discard an old friend?Lancet1994; 343: 618.
49.
LittenbergB.Aminophylline treatment in severe, acute asthma: A meta-analysis. JAMA1988; 259: 1678–84.
50.
SelfT., Abou-ShalaN., BurnsR.Inhaled albuterol and oral prednisone therapy in hospitalized adult asthmatics. Chest1990; 98: 1317–21.
51.
StraussR.E., WertheimD.L., BonaguraV.R.Aminophylline therapy does not improve outcome and increases adverse effects in children hospitalized with acute asthmatic exacerbations. Pediatrics1994; 93: 205–10.
52.
AbramowiczM.Drugs for asthma. Med Letter1995; 37: 1–4.
53.
SullivanP., BekirS., JaffarZ.Anti-inflammatory effects of low-dose oral theophylline in atopic asthma. Lancet1994; 343: 1006–8.
54.
KidneyJ., DominguezM., TaylorP.M.Immunomodulation by theophylline in asthma: Demonstration by withdrawal of therapy. Am J Respir Crit Care Med1995; 151: 1907–14.
55.
NelsonH.S.Beta-adrenergic bronchodilators. N Engl J Med1995; 333: 499–506.
56.
AbramowiczM.Salmeterol. Med Letter1994; 36: 37–9.
57.
BarrettT.E., StromB.L.Inhaled beta-adrenergic receptor agonists in asthma: More harm than good?Am J Respir Crit Care Med1995; 151: 574–7.
58.
van SchayckC.P., CloostermanS.G.M., HoflandI.D.How detrimental is chronic use of bronchodilators in asthma and chronic obstructive pulmonary disease?Am J Respir Crit Care Med1995; 151: 1317–19.
59.
BeasleyR., BurgessC., CraneJ.A review of the studies of the asthma mortality epidemic in New Zealand. Allergy Proc1995; 16: 27–32.
60.
ToogoodJ.H.Risk of anaphylaxis in patients receiving beta-blocker drugs. J Allergy Clin Immunol1988; 81: 1–5.
61.
AndersonC.J., BardanaE.J.Asthma in the elderly: Interactions to be wary of. J Resp Dis1995; 16: 965–76.
