Rational therapy of acute asthma.

Despite effective pharmacologic therapy, asthma remains a common cause of emergency room and hospital admissions, and mortality due to asthma is increasing. Asthma deaths often are related to failure on the part of patients or their physicians to appreciate the severity of their illness. Subjective assessment of the severity of airflow obstruction is unreliable and actual measurement of airflow and arterial blood gases should be utilized initially, as well as during therapy. An increasing awareness of the role of inflammation in the pathogenesis of asthma has led to pharmacologic therapy aimed both at producing bronchodilation and at reducing inflammation. Aggressive therapy with inhaled beta-adrenergic agonists and systemic corticosteroids remains the mainstay of treatment for acute asthma. Some patients may benefit from the addition of anticholinergic therapy and/or theophylline. If mechanical ventilation is required, controlled hypoventilation may decrease the incidence of pulmonary barotrauma. Although inhaled corticosteroids, cromolyn sodium, antihistamines and calcium-channel blockers are not effective in the treatment of acute asthma, inhaled steroids should probably be used in the recovery phase of most hospitalized asthmatics to decrease the bronchial hyperreactivity associated with airway inflammation.