When an expert panel recommended last week that asthma should be treated as an inflammatory disease, local specialists were not surprised.
"At least among the research people, that story has been around for a number of years," said Dr. Philip Norman, professor and head of clinical immunology at the Johns Hopkins Asthma and Allergy Center.
Asthma causes breathing problems for about 10 million Americans, most of them children. Traditionally, the wheezing, gasping and coughing of an asthma attack have been blamed on constriction of the breathing passages, and primary treatment has been with bronchodilating drugs, which relieve the symptoms by dilating, or widening, the bronchial tubes.
Now, however, a National Heart Lung andBlood Institute panel has announced that inflammation causes the constriction, and anti-inflammatory drugs should be used for prevention, in addition to bronchodilators for symptomatic relief.
In fact, asthma-preventing anti-inflammatories are already available, according to Robert Michocki, a professor in the University of Maryland's Schools of Medicine and Pharmacy. Unlike the anti-inflammatories used for arthritis relief, the anti-asthma kind are designed and packaged for oral inhalation, which gets the drug directly into the breathing tubes without, generally, affecting the rest of the body, he said.
They are of two types: One is known generically as "cromolyn sodium" and is marketed as "Intal." The other type is a steroid, which Dr. Norman recommends in two generic formulations: beclomethasone and flunisolide. Both of them are available under several brand names, he said.
Bronchodilators include a "beta-agonist" type usually taken by oral inhalation; it is produced in several generic and brand-name formulations. Bronchodilators based on "theophylline" or "aminophylline" come in tablet and liquid form, for sustained or immediate release.
The right type of drug or combination of drugs depends on the severity of the disease and the frequency of attacks.
Patients cannot create their drug regimen without a physician's advice, Dr. Norman said.*
Bronchodilators and anti-inflammatory drugs are listed in "Graedon's Best Medicine," by Joe and Teresa Graedon (Bantam, 1991); "Drug Information for the Consumer," (Consumer Reports Books, 1991); "The New Consumer Drug Digest," by the American Society of Hospital Pharmacists (Facts on File, 1985).