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September 1978

Rational Management of Bronchial Asthma

Author Affiliations

From the Thorndike Memorial Laboratories (Pulmonary Section), Department of Medicine, Boston City Hospital and Boston University School of Medicine.

Arch Intern Med. 1978;138(9):1394-1397. doi:10.1001/archinte.1978.03630340064020

Reassessment of rational management of bronchial asthma is timely considering the recent availability of a number of new therapeutic agents such as cromolyn sodium, beclomethasone dipropionate, and sympathomimetics with more specific β2 activity. In addition, there has been a resurgence of interest in the methylxanthine bronchodilators because of their utility. This review will emphasize a general approach to management since recent reviews1-3 have detailed dosages and mechanisms of action of the specific drugs.

Accurate differential diagnosis among the clinically similar but pathophysiologically different bronchial asthma, chronic bronchitis, and pulmonary emphysema is the important basis for selection of appropriate agents for the individual patient. The accepted definition and diagnostic criteria for bronchial asthma are useful.4 However, evidence of the allergic and bronchial pathophysiologic disturbance basic to asthma, such as sputum eosinophilia5 or the hyperreactive airways in response to methylcholine chloride, histamine, or specific antigen, should be documented.