Ancillary medical therapy: help or hindrance.

Aside from the more traditional methods of treating bronchial asthma, it has been the purpose of this review to consider some of the ancillary modes of therapy and to decide if they have a place in clinical practice. Regarding antihistamines, there is little evidence to support their therapeutic use in the management of asthma, but there is strong evidence for their safety in the treatment of allergic rhinitis or urticaria in asthmatic patients. Iodides have been used for years, but there is no good body of evidence to demonstrate their effectiveness. While they may be helpful in rare cases, one must be fully aware of their potential side effects and toxicity. Mucolytic agents induce bronchospasm and for the present should be contraindicated in asthma management. Of all ancillary modes of therapy, the anticholinergic agents seem the most promising. This is based on the theory of cholinergic mechanisms in asthma production as well as some clinical trials supporting this efficacy. Many of the problems of inhaled atropine have been eliminated with the development of atropinelike anticholinergic agents such as ipratropium bromide and oxytropium but unfortunately, none of these has been approved as yet for use in the United States.