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Editorials |

The Labyrinth of Asthma Therapy : Lost in the Choices

Jonathan E. Kass, MD, FCCP; Thaddeus Bartter, MD, FCCP
Author and Funding Information

Affiliations: Camden, NJ 
 ,  Drs. Kass and Bartter are affiliated with the Division of Pulmonary and Critical Care Medicine, Cooper Hospital/University Medical Center, UMDNJ/Robert Wood Johnson School of Medicine at Camden.

Correspondence to: Jonathan E. Kass, MD, FCCP, Division of Pulmonary and Critical Care Medicine, 3 Cooper Plaza, Suite 312, Camden NJ 08103



Chest. 2000;118(4):891-893. doi:10.1378/chest.118.4.891
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The pharmacologic treatment of asthma, which began centuries ago, has recently gained complexity at logarithmic rates. Centuries ago, the Chinese inhaled β-agonists from herbs containing ephedrine.1 Thousands of years later, in the 17th century, anticholinergic asthma treatments from Datura species were discovered, and these gained dominance until more refined adrenergic drugs evolved.1 Adrenaline was first used in asthma treatment at the turn of the 19th century.1 Then came the age of oral corticosteroids, which were found to be helpful and, in many instances, life-saving. With their success, however, came a plethora of serious side effects; it became evident that long-term systemic steroid therapy was a suboptimal solution. The evolution of pharmacotherapy accelerated, and selective β2-agonists were developed, with the promise of fewer adrenergic side effects. With the latter half of the 20th century came the introduction of inhaled steroids, which have now become first-line therapy for persistent asthma.2 Even more recently, long-acting selectiveβ 2-agonists and leukotriene inhibitors have been added to the asthma armamentarium. At present, patient care involves choices between different classes of drugs, different drugs in a class, different delivery mechanisms, different treatment intervals, and different combinations between, and within, classes of drugs. The number of combinations and permutations is considerable.

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    Print ISSN: 0012-3692
    Online ISSN: 1931-3543