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Leukotrienes are bronchoconstrictor and pro-inflammatory mediators implicated in asthma. Drugs that block leukotriene synthesis or activity are set to become the first major breakthrough in asthma therapy for 25 years. Antileukotriene drugs block bronchoconstriction after challenge with allergen, aspirin or exercise, and in clinical trials in patients with asthma they improve baseline lung function, reduce night-time awakenings, improve daytime symptom scores and halve the number of acute exacerbations. They are likely to be used as oral prophylactic therapy to reduce the dosage of corticosteroids right across the spectrum of asthma severity. Further studies on possible long term anti-inflammatory effects are currently in progress.