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Asthma is a chronic inflammatory disease of the lower respiratory tract which is triggered by exposure to allergens or other airway irritants, and is commonly encountered in otolaryngologic practice. This three-part review is designed to assist otolaryngologists in recognizing and managing asthmatic patients. Part one summarized current knowledge of the pathophysiology and increasing prevalence of asthma, and its assessment and diagnosis. Part two discussed asthma management by environmental controls, anti-inflammatory therapies, and patient education, and compared pharmacologic treatments which are not primarily anti-inflammatory. These include mucolytic, anticholinergic, antihistamine, theophylline and beta agonist drugs. In this final part, anti-inflammatory treatments for asthma control are critically reviewed, including a balanced discussion of cromolyn, nedocromil, glucocorticoids, allergy immunotherapy, and the appropriate indications, possible toxicities and reasonable precautions for their use.

Asthma is a chronic inflammatory disease of the lower respiratory tract which is triggered by exposure to allergens or other airway irritants, and is commonly encountered in otolaryngologic practice. This three-part review is designed to assist otolaryngologists in effectively managing their asthmatic patients. In Part I, current information on the pathophysiology and increasing prevalence of asthma, its clinical variability, the assessment of asthma severity and methods for diagnosis of asthma were summarized. Part 11 discusses a tripartite strategy for asthma management, based on environmental controls, the use of anti-inflammatory therapies and patient education. In addition, pharmacologic treatments which are not primarily anti-inflammatory are reviewed in detail. The uses, effectiveness, side effects and suitability for drug combination therapy for mucolytic, anticholinergic, antihistamine, theophylline and beta agonist drugs are compared, and the disadvantages of beta antagonists are summarized. Part III concludes with an overview of antiinflammatory therapies for asthma control.

Asthma is a chronic inflammatory disease of the lower respiratory tract which is triggered by exposure to allergens or other airway irritants. This inflammation results in airway hyperresponsiveness, bronchial muscle spasm, mucous gland hypersecretion and mucosal edema, which combine to create symptoms such as cough, wheezing and respiratory distress. Because the inflammatory process is highly variable, asthma is a disorder with many possible presentations. It may therefore proceed for years without clinical recognition, and may challenge the most astute diagnostician. It is important for otolaryngologists to be able to suspect, diagnose and treat asthma. This is so because asthma is a common disease in the otolaryngologic patient population, both as one of the options in the differential diagnosis of respiratory complaints, and as a comorbid condition which may complicate the treatment of other medical or surgical problems. Furthermore, both the understanding of asthma's pathophysiology, and its optimum treatment methods have undergone radical changes during the past decade. This three-part discussion reviews our modern understanding of asthma, and proposes diagnosis and treatment guidelines which can assist otolaryngologists in effectively managing their asthmatic patients. Part one summarizes current information on the pathophysiology and increasing prevalence of asthma, its clinical variability, the assessment of asthma sensitivity, and methods for diagnosis of asthma. Parts two and three cover the strategy for asthma management, and the use of both adjunctive and anti-inflammatory therapies for asthma control.

Allergic rhinosinusitis has three forms of therapy: pharmacotherapy, immunotherapy, and surgical therapy. Pharmacotherapeutically, there are six classes of drugs that give symptomatic relief: mucolytics, decongestants, anticholinergic agents, antihistamines, mast cell stabilizers, and corticosteroids. All six classes are discussed individually and in detail.For immunotherapeutic therapy of allergic rhinosinusitis, there are four types of skin testing in current use: scratch testing, prick testing, single intradermal testing, and skin end point titration testing. Only the latter is able to quantitate the antigenicity of each antigen, and thus the treatment vial made from only this type of skin testing can adequately treat all antigens to which the patient is sensitive. These differences in testing and vial mixing are explained.The last form of therapy is surgical therapy, which corrects the obstructive phenomenon caused by allergic rhinosinusitis. The procedures described are reduction inferior turbinectomies and endoscopic sinus surgery.It is felt by the authors that the specialist who is uniquely positioned to offer a patient suffering from allergic rhinosinusitis all three forms of therapy is the rhinologist.