Leukotriene inhibitors and non-steroidal therapies in the treatment of asthma.
Asthma is the most common chronic disease of childhood whose morbidity and mortality continues to rise [1]. Drugs used in the treatment of asthma must be targeted at reversing three principle pathophysiologic features: bronchoconstriction, mucus plugging/hypersecretion and inflammation. In the past two decades, the contribution of airway inflammation to the development and progression of asthma symptoms and airway pathology has become a critical focus. Chronic airway inflammation can lead to the progressive decline and irreversible loss of lung function and airway remodelling [2]. In recent years, therapies aimed at diminishing airway inflammation have been at the forefront of asthma management. Steroids have been extensively studied and used as primary anti-inflammatory agents in the management of the asthmatic patient with persistent symptoms of varying severity. Within the last decade, however, several additional non-steroidal classes of drugs have begun to emerge as anti-inflammatory agents for the treatment of asthma. This article will focus on these non-steroidal drugs which have been developed and investigated within the last 5 years. Particular emphasis will be placed on leukotriene receptor antagonists, but anti-IgE and anti-IL-4 therapies, as well as phosphodiesterase inhibitors will also be discussed. Of these new therapies, only two leukotriene receptor antagonists, montelukast (Singulairtrade mark, Merck) and zafirlukast (Accolatetrade mark, AstraZeneca) and the 5-lipoxygenase inhibitor, zileuton (Zyflotrade mark, Abbott Laboratories), have been recommended, approved and are currently available for use in the treatment of paediatric patients with asthma in the United States.
Krawiec
M E
ME
University of Wisconsin, Department of Pediatric Pulmonology, 600 Highland Avenue, K4/944, Madison, WI 53792-4108, USA. mekrawiec@facstaff.wisc.edu
Wenzel
S E
SE
D000085:Acetates / Q000627:therapeutic use; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D016084:Bronchoconstriction / Q000187:drug effects / Q000502:physiology; D002648:Child; D002986:Clinical Trials as Topic; D003521:Cyclopropanes; D006801:Humans; D006918:Hydroxyurea / Q000031:analogs & derivatives* / Q000627:therapeutic use; D007211:Indoles; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D048448:Phenylcarbamates; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011804:Quinolines / Q000627:therapeutic use; D013440:Sulfides; D013449:Sulfonamides; D014105:Tosyl Compounds / Q000627:therapeutic use; D016896:Treatment Outcome
D000085:Acetates; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D003521:Cyclopropanes; D007211:Indoles; D020024:Leukotriene Antagonists; D048448:Phenylcarbamates; D010726:Phosphodiesterase Inhibitors; D011804:Quinolines; D013440:Sulfides; D013449:Sulfonamides; D014105:Tosyl Compounds; C093875:montelukast; C063449:zileuton; D006918:Hydroxyurea; C062735:zafirlukast