Pulmonary Disease

Answer 1 Start therapy with a combination of a long-acting ß-agonist and an inhaled corticosteroid. 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. REFERENCE 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. Click here to return to the questions

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