POSSIBLE ALTERNATIVE TREATMENTS FOR ASTHMA

Lithium benefits some patients but causes too many side effects ... There have been several isolated reports of asthmatic patients who were treated with lithium carbonate, for manic depression and whose asthma subsequently improved. In a crossover study, 5 patients with asthma received 300mg lithium tid and placebo for 31 days. The dosage of lithium was titrated to maintain therapeutic serum levels. The mean results of symptom scores, salbutamol (albuterol) inhalations, peak expiratory flow rate (PEFR), and the ratio of FEV1 to vital capacity were no different between treatments. When considering individual patients, however, 2 lithium patients felt better and 2 had a better PEFR and used less salbutamol. Four out of 5 patients reported side effects: polydypsia, polyuria, frequency, headache, apathy and loss of concentration. Thus, although some patients may improve with lithium ' ... potentially severe and possibly irreversible side effects argue against treating asthmatic patients with lithium.' Spitz, E. et al.: Annals of Allergy 49: 165 (Sep 1982)

.. . and ipratropium bromide might be useful in some cases 50 asthmatic patients received 4 weeks' treatment with 0.04 mg tid ipratropium bromide or 0.2mg salbutamol, both drugs being inhaled. Seven patients withdrew, with only 2 stating any reason (dyspnoea). There were similar improvements in FEY ~o of about 25-35%, in the first half-hour after administration of either drug. Subsequent readings did not vary significantly. Percentage PEFR improvements were comparable between treatments. 25 patients expressed a preference for salbutamol compared with 9 for ipratropium bromide. Lung function tests thus showed similar efficacy and yet more patients preferred salbutamol. Since the reversibility of obstruction was initially assessed using a ~-stimulant, a bias against ipratropium bromide was inherent in the trial design. lpratropium bromide may thus offer a suitable alternative to ~-stimulants in the management of asthma. Bell, R. et al.: Current Medical Research and Opinion 8: 242 (No 4, 1982)

8 iNPHARMA 11 Dec 1982 0156-2703/82/1211-0008/0$01.00/0 © ADIS Press