INDICATIONS Intal Inhaler is a prophylactic agent indicated in the management of patients with bronchial asthma. In patients whose symptoms are sufficiently frequent to require a continuous program of medication, Intal Inhaler is given by inhalation on a regular daily basis. (See DOSAGE AND ADMINISTRATION). The effect of Intal Inhaler is usually evident after several weeks of treatment, although some patients show an almost immediate response. If improvement occurs, it will ordinarily occur within the first 4 weeks of administration as manifested by a decrease in the severity of clinical symptoms of asthma, or in the need for concomitant therapy, or both. In patients who develop acute bronchoconstriction in response to exposure to exercise, toluene diisocyanate, environmental pollutants, known antigens, etc., Intal Inhaler should be used shortly before exposure to the precipitating factor, i.e., within 10 to 15 minutes but not more than 60 minutes. (See DOSAGE AND ADMINISTRATION). Intal Inhaler may be effective in relieving bronchospasm in some, but not all, patients with exercise induced bronchospasm. DOSAGE AND ADMINISTRATION For management of bronchial asthma in adults and pediatric patients (5 years of age and over) who are able to use the Inhaler, the usual starting dosage is two metered inhalations four times daily at regular intervals. This dose should not be exceeded. Not all patients will respond to the recommended dose and there is evidence to suggest, at least in younger patients, that a lower dose may provide efficacy. Patients with chronic asthma should be advised that the effect of Intal Inhaler therapy is dependent upon its administration at regular intervals, as directed. Intal Inhaler should be introduced into the patient's therapeutic regimen when the acute episode has been controlled, the airway has been cleared, and the patient is able to inhale adequately. For the prevention of acute bronchospasm which follows exercise, exposure to cold, dry air, or environmental agents, the usual dose is two metered inhalations shortly before exposure to the precipitating factor, i.e., within 10 to 15 minutes but not more than 60 minutes. Intal Inhaler Therapy in Relation to Other Treatments for Asthma Non-steroidal agents: Intal Inhaler should be added to the patient's existing treatment regimen (e.g., bronchodilators). When a clinical response to Intal Inhaler is evident, usually within two to four weeks, and if the asthma is under good control, an attempt may be made to decrease concomitant medication usage gradually. If concomitant medications are eliminated or required on no more than a p.m. basis, the frequency of administration of Intal Inhaler may be titrated downward to the lowest level consistent with the desired effect. The usual decrease is from two metered inhalations four times daily to three times daily to twice daily. It is important that the dosage be reduced gradually to avoid exacerbation of asthma. It is emphasized that in patients whose dosage has been titrated to fewer than four inhalations per day, an increase in the dosage of Intal Inhaler and the introduction of, or increase in, symptomatic medications may be needed if the patient's clinical condition deteriorates. Corticosteroids: In patients chronically receiving corticosteroids for the management of bronchial asthma, the dosage should be maintained following the introduction of Intal Inhaler. If the patient improves, an attempt to decrease corticosteroids should be made. Even if the corticosteroid-dependent patient fails to show symptomatic improvement following Intal Inhaler administration, the potential to reduce corticosteroids may nonetheless be present. Thus, gradual tapering of corticosteroid dosage may be attempted. It is important that the dose be reduced slowly, maintaining close supervision of the patient to avoid an exacerbation of asthma.