Treating asthma: is there a place for leukotriene receptor antagonists?
Asthma is a chronic disorder, characterized by airway hyperresponsiveness (AHR), airway inflammation and airway remodelling. Evidence has been provided for a relationship between pathophysiology, airway inflammation and remodelling. Moreover, these asthma features have been shown to respond to anti-inflammatory therapy. According to current guidelines, monitoring of asthma is predominantly based on symptoms and lung function data. However, these parameters appeared as poor indices for asthma control. Alternatively, asthma control relates well to exacerbations and (anamnestic) surrogate biomarkers of airway inflammation. Hence, appropriate treatment of asthma should primarily target the airway inflammation. According to current guidelines for asthma management, anti-inflammatory therapy with inhaled corticosteroids (ICS) is the cornerstone in the treatment of persistent asthma. To further optimize asthma control, add-on therapy with long-acting beta2-agonists (LABA) or leukotriene receptor antagonists (LTRA) should be combined with low to high doses of ICS. While the first combination focuses on optimal control of symptoms and lung function, the second provides a more complete suppression of the airway inflammation. In this paper we discuss treatment of asthma according to current guidelines versus new insights, addressing practical issues.
Diamant
Zuzana
Z
Centre for Human Drug Research, Zernikedreef 10, 2333 CL Leiden, The Netherlands. z.diamant@gems.demon.nl
van der Molen
Thys
T
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology; D001980:Bronchi / Q000276:immunology; D016535:Bronchial Hyperreactivity; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008168:Lung / Q000276:immunology; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000318:Adrenergic beta-Agonists; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D020024:Leukotriene Antagonists