pulmonary disorders
Drug Treatment of Asthma
Other drugs
Other drugs are used in asthma treatment uncommonly and in specific circumstances. Magnesium is often used in the emergency department, but it is not recommended in the management of chronic asthma. Immunotherapy may be indicated when symptoms are triggered by allergy, as suggested by history and confirmed by allergy testing. Immunotherapy is generally more effective in children than adults. If symptoms are not significantly relieved after 24 months, then therapy is stopped. If symptoms are relieved, therapy should continue for≥3 years, although the optimum duration is unknown. Other drugs that suppress the immune system are occasionally given to reduce dependence on high-dose oral corticosteroids, but these drugs have a significant risk of toxicity. Low-dosemethotrexate(5 to 15 mg orally or IM once a week) can lead to modest improvements in FEV1 and modest decreases in daily oral corticosteroid use. Gold andcyclosporineare also modestly effective, but toxicity and need for monitoring limit their use. Other therapies for management of chronic asthma include nebulizedlidocaine, nebulizedheparin,colchicine, and high-dose IV immune globulin. Limited evidence supports the use of any of these therapies, and their benefits are unproved, so none are currently recommended for routine clinical use. 