This patient with daily symptoms and frequent
nocturnal awakenings has moderate persistent asthma. The 1997 National
Institutes of Health (NIH) Guidelines for the Diagnosis and Treatment
of Asthma suggest daily maintenance therapy with a low to medium dose
of an inhaled corticosteroid plus a long-acting ß-agonist and a short-acting
ß-agonist for rescue.1 A leukotriene modifier along with a
long-acting ß-agonist may be an acceptable alternative treatment. This
patient should also receive asthma education and an asthma action plan.
Anticholinergic therapy (eg, with ipratropium bromide) is more
effective in chronic obstructive pulmonary disease than in asthma
and has limited indications in asthma. Antibiotics (eg, clarithromycin)
are not indicated for chronic asthma and should only be used to treat
specific infections such as sinusitis.
- Start therapy with a combination of a long-acting ß-agonist and an
1. National Asthma Education and Prevention Program Expert
Panel Report 2: Guidelines for the diagnosis and management of asthma.
Bethesda (MD): National Heart, Lung, and Blood Institute; 1998. NIH
Publication No. 98-4051.
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