New developments in bronchodilator therapy.

Generally favorable literature was published regarding the contributions of bronchodilators to asthma therapy. Analysis of asthma mortality data suggested that the risk of death from asthma was primarily associated with the use of fenoterol rather than beta-adrenergic bronchodilators as a class, or reflected the severity of the underlying asthma, which resulted in increasing beta-agonist use. Salmeterol was shown to outperform oral beta-adrenergic agonists and individual dose-titrated theophylline in controlling asthma symptoms while causing fewer adverse effects. When salmeterol was added to low-dose inhaled corticosteroids, the combination outperformed moderate-dose inhaled corticosteroids alone. Regular use of salmeterol, but not albuterol, improved the quality of life for patients with asthma to a clinically significant degree. Finally, theophylline, at relatively low blood levels, was clearly shown to improve asthma control, even in patients receiving moderately high-dose inhaled corticosteroids. More importantly, this symptomatic response was accompanied by decreases in activated lymphocytes, eosinophils, and proinflammatory cytokines in bronchial biopsy results.