Management of Asthma and Chronic Airflow Limitation (Part 6)
Because cromolyn is effective, has minimal, if any, side effects, does not require the monitoring of serum concentrations and has a far greater margin of safety, it may be considered as first-line therapy together with inhaled adrenoceptor agonists to control mild to moderate asthma. Aerosol corticosteroids are more effective in the management of more severe childhood asthma and should be substituted for cromolyn rather than added to it. buy flovent inhaler
Two groups of patients with asthma may benefit from the addition of theophylline to their maintenance therapy. There is some evidence that children with severe steroid-dependent asthma may sometimes benefit from adding theophylline as a systemic steroid-sparing strategy. In one study, improvement was noted both clinically and in pulmonary function tests. This type of patient with severe asthma, inadequately controlled by maximum doses of inhaled steroids, is nowadays, relatively uncommon in practice.
It also has been shown that single-dose slow-release aminophylline at night may prevent symptoms in patients with nocturnal asthma. However, nocturnal symptoms reflect suboptimal asthma control, and control of asthma can almost always be improved with higher doses of aerosol corticosteroids which usually results in improvement of lung function airway-reac-tivity and symptoms including nocturnal symptoms in these patients.* Nocturnal asthma-like symptoms may indicate an associated and undiagnosed problem of gastroesophageal reflux which could actually be made worse by methylxanthines. Treatment of the reflux may relieve nocturnal symptoms of cough, wheeze and breathlessness and lead to more effective control of asthma.