Current Global Initiative for Asthma (GINA) guidelines recommend LTRAs
as a monotherapy in mild persistent asthma, as an add-on or alternative to increasing dose of ICS or adding a long-acting [beta]2-agonist.
have a rapid onset of action (1-3 hours) and are taken once a day.
However, the relative place and preference of tiotropium with respect to other potential GINA Step 4 strategies (e.g., theophylline and leukotriene receptor antagonists (LTRAs
)) have yet to be addressed directly by large, blinded, randomized trials.
All of the oral medications including LTRAs
, xanthine, LABA, and systemic corticosteroids as a controller dose showed the consistent result that oral asthma medications were less used during pregnancy than before and after pregnancy (Table 2).
[sup] That was the cue that LTRAs
may involve different mechanisms from that of corticosteroid, since ICSs do not suppress cough sensitivity.
Although ICSs are the preferred first line preventive therapy for children with persistent asthma, the National Heart, Lung, and Blood Institute Guidelines for the management of asthma recommend LTRAs
as alternative first line therapy or adjunctive therapy for patients with persistent asthma not controlled on ICS alone (Expert Panel Report 3 [EPR- 3], 2007).
Montelukast, marketed under the brand name Singulair, and zafirlukast (Accolate) are the most popular of the LTRAs
. Children and adults who have allergic rhinitis and asthma symptoms tend to do best using a combination of a good antihistamine such as Zyrtec and a good LTRA
such as Singulair.
They gave one group glucocorticoid inhalers and the other group LTRAs
. After two years, researchers concluded that the therapies were equally effective.
The data from the two studies support this view, since the rates of adherence to the oral LTRAs
were 65% and 74% in the first-line controller and add-on therapy trials, respectively, compared with only 41% and 46% for the inhaled glucocorticoid.'"
In the first study 306 patients were randomly assigned to open-label treatment with either an LTRA
(montelukast or zafirlukast) or an inhaled glucocorticoid (beclomethasone, budesonide, or fluticasone) as first-line therapy.
, sold under the brand names Singulair and Accolate, have long been available as alternative treatments to ward off asthma attacks.
They found that tablets called leukotriene receptor antagonists (LTRAs
) managed the disease equally successfully as steroid inhalers and other "preventer" inhalers when used in addition to steroid inhalers.