The use and abuse of drugs in the treatment of asthma in children.

ASTHMA is among the serious manifestations of allergic disease for which patients require immediate relief. Because of its chronicity and tendency to recur there has been a continuous search for more effective symptomatic treatment. A large number of drugs have been developed which are purported to relieve the symptoms of asthma. They are used and often abused to an extent which may actually endanger the life of the patient. For some diseases, in which only one effective remedy is available, a calculated risk is justified to save the life of an individual. Under these circumstances the value of such treatment outweighs its danger. This situation should not often arise with asthma, for which the choice of remedies is wide enough to make it possible to avoid any one which may be hazardous in a particular patient. Let us, therefore, take stock of the measures used in the treatment of asthma and evaluate their respective merits. We will begin with an example of a child who died from bronchial asthma after a surgical operation and whose case was presented at a hospital conference: Post-mortem examination disclosed that the entire bronchial tree was completely filled with thick, gelatinous fluid. A discusser at the conference quite rightly criticized the use of atropine and stated that bronchoscopic aspiration, postural drainage and nasotracheal intubation should have been instituted. He added that adrenal steroids had also been indicated. To my astonishment he went on to recommend antihistaminics, aminophylline and epinephrine before, during and after anesthesia. This discussion leaves one dismayed, for with a plugged bronchial tree many of the drugs suggested by the critic are as contraindicated as was the atropine. Antihistaminics, for example, with their drying, atropine-like action, are specifically contraindicated.