Inhalation cortisone therapy in bronchial asthma.

In its original concept, the term “allergy” was used to denote the changed state of the organism that followed the parenteral introduction of an antigen. Although the role of the adrenal corticoids in relation to this altered tissue state is not clear, it appears that in some way they interfere with tissue production of substances which are detrimental to cellular integrity, and thus permit a return to normal cellular homeostasis. This concept offers a rational therapeutic basis for the beneficial effects observed to date in the treatment of acute bronchial asthma with cortisone and/or ACTH. The predominant pathological findings in bronchial asthma are dilatation of capillaries, edema of the bronchial wall, spasm of bronchial musculature, hyperplasia of goblet cells, and eosinophilic infiltration of the bronchial wall, and pen-bronchial tissue. In addition, thick inspissated mucus plugs are frequently present. Because of the favorable response of allergic inflammatory reactions associated with certain diseases of the eye23 and skin,4 it was felt that the disturbed tissue alterations of bronchial asthma might be similarly benefited by direct contact with cortisone. The undesirable side-effects and complications56 noted in some instances with other methods of administration of this corticosteroid appeared to make it even more important to investigate this therapeutic approach. It was therefore decided to administer cortisone by inhalation to patients with bronchial asthma, and to compare this method of therapy with parenteral cortisone administration in these patients.