Antileukotrienes as adjunctive therapy in acute asthma

The leukotriene receptor antagonists (LTRAs) are a comparatively new class of asthma drugs that exhibit both bronchodilator and anti-inflammatory properties. There is a substantial body of evidence for their benefit in the management of chronic asthma in both adults and children, and particularly in specific types of asthma such as exercise-induced and aspirin-sensitive asthma. Despite best practice using current treatment guidelines for the management of acute asthma, a significant proportion of patients require continued treatment and are unable to be discharged from the emergency department; many require a short course of oral corticosteroids. The relatively rapid onset of action of LTRAs after oral administration and their additive effect to beta(2)-adrenoceptor agonists led to the hypothesis that they might be of benefit in acute asthma. This review examines the available evidence for the effect of LTRAs in acute asthma. Although the evidence is limited, it suggests that treatment with LTRAs provides additional bronchodilator effect to nebulised and inhaled beta(2)-adrenoceptor agonists. Short-term therapy with LTRAs results in fewer treatment failures and readmissions for patients with acute asthma, and less need for additional therapies such as nebulisers and corticosteroids.