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Leukotriene antagonists. Do they offer new hope for asthmatics?
1Department of Allergy, Asthma and Clinical Immunology, Alfred Hospital, Monash Medical School, Melbourne, Victoria.
Background:
Leukotrienes are potent chemical mediators important in allergic inflammation. Leukotriene receptor antagonists are a new class of oral asthma drugs which target and block the action of these mediators.
Objective:
To review the action of leukotrienes and the clinical effects of leukotriene receptor antagonists in asthma.
Discussion:
Leukotrienes mediate bronchospasm, airway oedema, mucus hypersecretion and increased airway reactivity. Leukotriene receptor antagonist drugs have a mild short and long term bronchodilator effect, with evidence of an anti inflammatory effect. The clinical benefits include improved symptoms, reduced rescue bronchodilator requirements, and reduced inhaled steroid requirements. Their oral formulation may provide improved adherence compared to inhaled medication. Clinical studies suggest they may be less efficacious than inhaled steroids or long acting beta 2 agonists in improving lung function and symptom control, but there was a heterogeneity in response to all classes of asthma drugs. Hence, currently, the only way to judge effectiveness is a therapeutic trial for 4-6 weeks. Although they are unlikely to replace currently available asthma medication, they are likely to be useful adjuncts to treatment.
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