Critical appraisal of antileukotriene use in asthma management.
OBJECTIVE
Recognition of the importance of leukotrienes in the pathogenesis of asthma has led to the development of leukotriene modifiers, the first new class of drugs for asthma treatment to become available since the introduction of inhaled corticosteroids. Nevertheless, despite their widespread use in clinical practice, the role of leukotriene modifiers in the management of asthma remains controversial. In the present article the clinical applications of this class of drugs have been critically reviewed based on recent evidence.


RESULTS
In an effort to try and establish the proper place of antileukotrienes in the management of asthma, important systematic reviews have been carried out over these recent years in three critical areas: antileukotrienes as second choice first line agents after inhaled corticosteroids; antileukotrienes as add-on therapy to inhaled corticosteroids; add-on antileukotrienes versus long acting beta-agonists to patients not controlled by inhaled corticosteroids. In addition, novel and useful clinical targets for this class of drugs have been recently explored and include: patients with severe asthma; aspirin-intolerant asthma; asthmatic patients with allergic rhinitis.


CONCLUSIONS
Use of antileukotrienes is not recommended as first-line monotherapy in patients with asthma, except those who have aspirin intolerant asthma. Patients with concomitant allergic rhinitis may be a good target population for therapy with antileukotrienes. Addition of leukotriene modifiers to inhaled corticosteroids produces only a modest improvement in the clinical response, and is not greater to that of add-on long acting beta-agonists. The exact role of antileukotrienes in asthma management guidelines still continues to evolve.
Polosa
Riccardo
R
Department of Internal and Specialist Medicine, Ascoli-Tomaselli Hospitals, University of Catania, Italy. polosa@unict.it
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D004359:Drug Therapy, Combination; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D015289:Leukotrienes / Q000502:physiology; D017410:Practice Guidelines as Topic; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists; D015289:Leukotrienes