Dictionary of Allergies .. Asthma treatment

Asthma treatment

Anti-inflammatory treatment with inhaled corticosteroids improves lung function, decreases symptoms, reduces asthma exacerbations, and has been the cornerstone of treatment of asthma for more than two decades[1].

Current guidelines recommend inhaled corticosteroids as first line treatments for patients with persistent asthma[1, 2] However, many patients remain symptomatic despite inhaled corticosteroid treatment, and inflammation of the airways may persist during treatment with inhaled and even oral corticosteroids[3] Increasing the dose of inhaled corticosteroids is one therapeutic option. However, at higher doses side effects become a concern due to a narrow therapeutic index, and responses are variable[4] implying that such doses may not necessarily treat asthma more effectively. Adding an inhaled long acting β agonist to an inhaled corticosteroid is more effective in improving lung function and reducing symptoms[5, 6] and asthma exacerbations[7]

Combination treatment is therefore recommended in current guidelines to achieve additional control[1, 2].

An alternative approach is to add a leukotriene receptor antagonist to an inhaled corticosteroid[8] Cysteinyl leukotrienes released by eosinophils and mast cells mediate pro-inflammatory events in asthma[9] Montelukast is a leukotriene receptor antagonist that improves asthmatic inflammation and prevents bronchoconstriction[10, 11]

References

1. National Institutes of Health, National Heart, Lung and Blood Institute. Asthma management and prevention. Global initiative for asthma. A practical guide for public health officials and health care professionals. Based on the global strategy for asthma management and prevention NHLBI/WHO workshop report. Bethesda, MD: NIH, 1995. (NIH publication No. 96-3659A.) Updated report 2002. http://www.ginasthma.com (accessed 28 Aug 2003).

2. British asthma guidelines coordinating committee. British guidelines on asthma management: 1995 review and position statement. Thorax 1997;52: S1-24.

3.El-Radhi AS, Hogg CL, Bungre JK, Bush A, Corrigan CJ. Effect of oral glucocorticoid treatment on serum inflammatory markers in acute asthma. Arch Dis Child 2000;83: 158-62.

4. Barnes PJ. Efficacy of inhaled corticosteroids in asthma. J Allergy Clin Immunol 1998;102: 531-8

5. Greening A, Wind P, Northfield M, Shaw G. Added salmeterol versus higher-dose corticosteroid in asthma patients with symptoms on existing inhaled corticosteroids. Lancet 1994;344: 219-24.

6. Woolcock A, Lundback B, Ringdal N, Jacques L. Comparison of addition of salmeterol to inhaled steroids with doubling of the dose of inhaled steroids. Am J Respir Care Med 1996;153: 1481-8.

7.Pauwels RA, Löfdahl C-G, Postma DS, Tattersfield AE, ÓByrne P, Barnes PJ, et al. Effect of inhaled formeterol and budesonide on exacerbations of asthma. N Engl J Med 1997;337: 1405-11.

8. Laviolette M, Malmstrom K, Lu S, Chervinsky P, Pujet JC, Peszek I, et al. Montelukast added to inhaled beclomethasone in treatment of asthma. Montelukast/Beclomethasone Additivity Group. Am J Respir Crit Care Med 1999;160: 1862-8.

9.Drazen JM, Israel E, O'Byrne PM. Treatment of asthma with drugs modifying the leukotriene pathway. N Engl J Med 1999;340: 197-206.

10.Pizzichini E, Leff JA, Reiss TF, Hendele L, Boulet LP, Wei LX, et al. Montelukast reduces airway eosinophilic inflammation in asthma: a randomized, controlled trial. Eur Respir J 1999;14: 12-8.

11. Villaran C, O'Neill SJ, Helbling A, van Noord JA, Lee TH, Chuchalin AG, et al. Montelukast versus salmeterol in patients with asthma and exercise-induced bronchoconstriction. Montelukast/Salmeterol Exercise Study Group. J Allergy Clin Immunol 1999;104: 547-53