Within each month, we counted the days the patient was covered by any controller medication (ICS, LTRA
, LABA, or ICS-LABA) based on the prescription fill date and days of supply, then divided this by the number of days in the month.
13) evaluated the effects of another LTRA
This observation provides different clues about a possible adjunctive anti-inflammatory role of LTRAs
Once we determined that the ratio was a significant predictor of emergent healthcare visits and whether or not to include LTRA
in the ratio, we then determined which ratio cut-point is most appropriate.
If the child is not responding, the provider must decide what step to take next--increase the ICS dosage, add a LTRA
, or change the treatment to a ICS/LABA combination (Lemanske et al.
Combination therapy typically involves antihistamines to block the histamine released from mast cells and basophils, LTRAs
(leukotriene receptor antagonists) to block leukotrienes, and nasal corticosteroids to block the various inflammatory mediators that participate in allergic reactions.
In the first study, 306 patients were randomly assigned to openlabel treatment with either an LTRA
(montelukast or zafirlukast) or an inhaled glucocorticoid (beclomethasone, budesonide, or fluticasone) as first-line therapy.
In the second study, 352 patients whose asthma "was not well controlled with inhaled glucocorticoids were randomly assigned to open-label add-on treatment with either an LTRA
or a long-acting beta-agonist.
, sold under the brand names "Singulair" (montelukast) and "Accolate" (zafirlukast), have long been on the market as an alternative to the steroid inhalers commonly used by asthmatics to ward off attacks.
Although the proportion of children who had a best response to LABA was significantly greater than with the other two treatments, "many children demonstrated a best response to either ICS or LTRA
step-up therapy, highlighting the need to regularly monitor and appropriately adjust each child's asthma therapy," Dr.
PM) Severe persistent [less than or equal to]60% >30% Moderate persistent 60-80% >30% Mild persistent [greater than or equal to]80% 20-30% Mild intermittent [greater than or equal to]80% <20% Severity Controller therapy options Severe persistent High-dose iGC plus LABA or LTRA
or sustained-release theophylline and/or LABA tablet Oral GC as needed Moderate persistent Medium dose iGC or low dose iGC plus LABA or LTRA
or sustained-release theophylline or LABA tablets Mild persistent Low-dose iGC or nedocromil or cromolyn or LTRA
(sustained-release theophylline is an alternative) Mild intermittent No daily medication is needed (a) iGC, inhaled glucocorticoid; LABA, long-acting [beta]-agonist (inhaled); LTRA
, leukotriene-receptor antagonist; PEFR, peak expiratory flow rate; FE[V.
In view of the fact that the companies' market share in most EEA states is equal or less than 30%, the strong position of rival firm Glaxo Wellcome (itself the product of another big merger) and other competitors such as Novartis, Rh"ne-Poulenc and Merck, which has also developed an LTRA
, the merger "did not raise competition concerns with regard to anti-asthmatics", the Commission concluded