[Antileukotrienes in the therapy of bronchial asthma]

Cysteinyl-leukotrienes (Cys-LTs) are mediators released in bronchial asthma and are both direct bronchoconstriction and proinflammatory substances that mediated several steps in the pathophysiology of chronic asthma, including inflammatory cells recruitment, vascular leakage, and possibly airway remodelling. Available evidence from clinical trials and real-word experience derived from managing patients with asthma justifies a broader role for antileukotriene drugs (anti-LTs) in asthma management than that recommended in the National Asthma Education and Prevention Program and National Institute of Health treatment guidelines. Anti-LTs seem to be effective alternatives to inhaled corticosteroids (ICS) either as monotherapy or as adjunctive therapy that reduces the need for higher doses of ICS in patients with mild-to-moderate persistent asthma. This class of drugs may be used as adjunctive therapy for all levels of disease severity because they are effective in combination with ICS during long-term maintenance therapy. The anti-LTs seem especially effective in preventing aspirin-induced asthma providing an additional advantage of reducing nasal congestion in patients with both asthma and rhinitis and in the treatment of exercise induced-asthma. This class of drugs have several features that are likely to promote adherence to treatment and are generally well tolerated. The available clinical data suggest that anti-LTs should be considered as a therapeutic option or as additive therapy in patients with mild to severe asthma.