Leukotriene Receptor Antagonists

Marzena E. Krawiec, MD, Nizar J. Jarjour, MD


Semin Respir Crit Care Med. 2002;23(4) 

In This Article


The LTRA drugs consistently demonstrate both bronchodilator and anti-inflammatory properties. Presently, the Expert Panel Report II indicates that LTRA drugs could be used as alternatives to (low-dose) ICS or cromolyn/ nedocromil in the long-term management of mild, persistent asthma.[107] Comparison studies using LTRA drugs in the mild persistent population favor low-dose ICSs to the LTRAs in adult studies based on lung function and several clinical parameters. Therefore, in general, perhaps the greatest current application of the LTRAs is as add-on therapy in asthmatics still symptomatic on moderate- to high-dose ICS. Whether these drugs are superior or even equivalent to long-acting beta2-agonists in this situation awaits the outcome of ongoing trials.

In general, consideration for the use of an LTRA should be entertained in the patient who requires mild controller therapy but can be managed without ICS (therefore, use as a second-line controller therapy), is noncompliant, or is steroid phobic. Further indications in the asthmatic patient for the initiation of LTRA therapy include (1) the mild asthmatic with a significant EIB component, (2) potentially, the ASA patient, and (3) the asthmatic who remains symptomatic on moderate- to high-dose ICS as add-on therapy and potentially for steroid-sparing benefit. Their safety profiles and ease of administration warrant further consideration of the LTRAs as second-line controllers in mild persistent asthmatics, especially in the pediatric population and as additional therapies to maximize clinical management in the moderate patient without further increasing baseline inhaled or oral steroids.


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