Management of Asthma and Chronic Airflow Limitation (Part 1)
Methylxanthines have, for almost 50 years, been regarded as first-line therapy in the management of airflow obstruction due to asthma and bronchitis in adults and children. In recent years, however, the therapeutic emphasis has shifted from simply managing the bronchoconstriction associated with these conditions, to treating the underlying inflammation, thus preventing bronchospasm. At the same time, drug targeting to the airways by means of inhaled aerosol medications, to take advantage of the greatly improved therapeutic ratio, has increasingly replaced ingested adrenoceptor agonists and theophylline therapy in many parts of Europe and North America. This article attempts to critically review the present role of methylxanthines alone or in combination with adrenoceptor agonists, anticholinergic agents and steroids in the management of airflow obstruction and raises the possibility that, except in a minority of carefully selected patients, methylxanthines may be on the verge of obsolescence, having been largely superceded by the more effective and less toxic inhaled broncho-dilators and steroids. flovent inhaler
Role of Aminophylline in the Management of Life-Threatening Asthma
Asthma, even when fairly mild, is characterized by airway inflammation associated with vascular hyperpermeability, hypersecretion, impaired mucociliary transport and hyperresponsiveness and bronchospasm of airway smooth muscle, leading to variable, sometimes severe, but usually largely reversible airflow obstruction. Pharmacotherapy may include betaa adrenoceptor agonists and anticholinergic bronchodi-lators, methylxanthines, cromolyn and corticosteroids.