The Care of Asthma Patients

THERE iS little doubt that most doctors regard the outlook for their asthmatic patients with pessimism. Often the available literature has been sifted and the recommended treatments faithfully carried out, and yet the patient is no better. Small wonder if the busy practitioner, surrounded with patients for whom he reallv can do something, pushes aside the idea of further attempts at curative treatment for asthma, and is content to rely almost on symptomatic remedies. The writer has been privileged to see large numbers of these cases during the past twelve years, and, although he has been appalled at the large amount of misery caused by the severer forms of this complaint, he has gradually come to regard the prognosis for the majority of patients with optimism. Perhaps one-fifth suffer from an obscure type of asthma which at present resists all efforts at treatment, but in the remaininig four-fifths the severity and frequency of attacks can be greatly (liminished anid quite a number cease having attacks altogether. '[he specialist, concentrating his energies in a limited field, has unique opportunities for observing the results of various forms of treatment, and he gradually becomes enthusiastic about some and rejects others. \Vith the increase in knowledge and experience, certain principles emerge, so that he can, as it were, hand back to the general practitioner certain methods in a simplified and greatly improved form. His services will always be required for the difficult cases, but we are approaching a stage at wlhich the general practitioner can deal effectively with straightforward cases, especially when no specialist advice is available. It would be impossible in this brief article to deal comprehensively with the subject, but it may be of interest to discuss briefly some of the points which seem to the writer to be important, and to go into more detail here and there. Success depends very much on minute attention to detail, and especially on recognition of those f(actors zehich are really concerned in causing this disord.er. Ihis point cannot be stressed too strongly, because failure will almost inevitably follow if an important "cause" is ignored. Other essentials are thorough investigation, precise classification of cases, recognition and elimination of associated diseases, and effective attention to environment, diet, and general routine. In allergic cases really potent extracts both for investigation and treatment and skill and persistence in using them are absolutely essential. The intelligent patient must be …