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DAVID M. SCHRECK, M.D., M.S., FACP, FACEP, is Chairman, Department of Emergency and Hospital Medicine, Summit Medical Group, 80 Division Avenue, Summit, NJ 27599-0001 (dschreck{at}comcast.net). DENNIS M. WILLIAMS, PHARM.D., BCPS, AE-C, is Associate Professor, University of North Carolina, Division of Pharmacotherapy and Experimental Therapeutics, School of Pharmacy, Kerr Hall #7360, Chapel Hill, NC (dwilliams{at}unc.edu).

Purpose. Considerations that enter into decisions about treatment strategies for acute and chronic asthma are illustrated in two case studies. Summary. A patient’s signs, symptoms, vital signs, laboratory test results, recent history of illness or exposure to substances that can provoke asthma symptoms, and response to recently used asthma medications as well as efficacy, safety, and cost are important considerations in choosing drug therapy in the emergency department to treat an acute exacerbation. The need for a rapid onset of action and patient limitations may influence the choice of a dosage form, delivery device, and route of administration. Treatment strategies for patients with chronic asthma may require resolution of problems with adherence to the treatment plan or inhaler technique. Long-term control of asthma symptoms involves the use of preventive measures, including long-term-control medications, efforts to control asthma triggers, and self-monitoring of pulmonary function. Patient education and a written action plan are important elements of the treatment strategy. Conclusion. An individualized approach to treating patients with acute or chronic asthma that takes into consideration patient-specific factors as well as efficacy, safety, and cost of drug therapy is needed when devising and implementing a treatment strategy to optimize patient outcomes. Index terms: Asthma; Compliance; Costs; Dosage forms; Drug administration; Drugs; Economics; Inhalers; Patients; Toxicity