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PULMONOLOGY
The treatment of asthma
Controllers
Relievers
Anti-
inflammatory
action to prevent
asthma attacks
Asthma prevalence
is increasing
worldwide and
surveys indicate
that the majority
of patients in
developed and
developing
countries do not
receive optimal
care.
Inhaled
corticosteroids
• Beclomethasone
• Budesonide
• Fluticasone
• Ciclesonide
• Mometasone
Leukotriene modifiers
• Montelukast
Oral corticosteroids
• Prednisone
• Prednisolone
• Methylprednisone
• Methylprednisolone
Sustained bronchodilator
action but weak or unproven
anti-inflammatory effect
For quick relief of symptoms
and use in acute attacks
as PRN dosage only
Short-acting β 2 agonists
• Salbutamol
• Fenoterol
• Terbutaline
Anticholinergics
• Ipratropium bromide
Long-acting β 2 agonists
• Salmeterol
• Formoterol
Long-acting anticholinergics
• Tiotropium
Sustained-release
theophylline tablets
Figure 1:
Classification of drugs used in the
maintenance treatment of asthma
T
he goal of asthma treatment is to
achieve control of the disease for
prolonged periods, taking into account
the safety and cost of treatment
required to achieve this. This article provides a
brief overview of treatments available for asthma
maintenance treatment, as well as newer
therapeutic options.
1. Implementing treatment
for chronic asthma
Dr Claudia Gray
MBChB, FRCPCH, MSc, PhD,
Dip Allergy, DipPaedNutrition.
Division of Allergology, Red
Cross War Memorial Children’s
Hospital and University of
Cape Town Lung Institute
12
|
May 2017
Avoidance of triggers, wherever possible,
helps to minimise asthma severity and reduces
asthma exacerbations. This includes avoidance of
exposure to personal and second-hand tobacco
smoke, reduction in exposure to furry animals,
pollen, house dust mite and other allergens
in those asthmatics known to be allergic,
avoidance of sensitisers and irritants (dust and
fumes) which aggravate or cause asthma, and
avoidance of drugs that may aggravate asthma
such as β blockers, aspirin and nonsteroidal anti-
inflammatory drugs.
Pharmacotherapy is the cornerstone
of asthma management, with appropriate
medications and delivery devices to meet
patients’ needs and circumstances.
When asthma is first diagnosed, it is
convenient for implementation of treatment to
classify it by SEVERITY as mild intermittent or
chronic persistent asthma that is mild, moderate
or severe.
After therapy is initiated, the emphasis for
clinical management changes to the assessment
of asthma CONTROL, which is the degree
to which the manifestations of asthma are
minimised by therapeutic intervention and the
goals of therapy are met.
The Specialist Forum | Vol. 17 No. 4