Pharma Blog Online

In the light of recent evidence on the role of leukotriene receptor antagonists in patients with asthma, Drug and Therapeutics Bulletin (DTB) reconsiders conclusions it reached about these pharmacotherapys in 1998.

Current British guidelines advise that leukotriene antagonists should be considered as an add-on therapy in patients whose asthma is inadequately controlled by regular inhaled corticosteroid in conventional doses.

The evidence now available suggests that the leukotriene receptor antagonists, montelukast and zafirlukast, are suitable as add-on pharmacotherapy in patients with mild or moderate asthma inadequately controlled by conventional doses of inhaled corticosteroid plus use of an inhaled short-acting beta2 agonist.

However, the average additional clinical benefit of adding such pharmacotherapy appears slight, according to DTB, and at least in adults is generally less than that of inhaled long-acting beta2 agonist therapy. Therefore, an inhaled long-acting beta2 agonist should generally be tried first.

However, only montelukast is both licensed and known to be effective in children under 4-5 years old, and so is the preferred add-on pharmacotherapy in this age group.

Leukotriene receptor antagonists are a possible option for people with exercise-induced asthma, but these symptoms may indicate inadequate control of the asthma and should prompt a broader review of asthma preventative pharmacotherapy.

Further research is needed on whether leukotriene receptor antagonists could offer added clinical benefits to particular groups of patients, such as those with seasonal allergic rhinitis, those with aspirin-intolerant asthma, and young children with recurrent wheezing.

Dr Ike Iheanacho, editor, DTB, said:

“In general, there appears to be only modest additional clinical benefit from using leukotriene receptor antagonists as add-on therapy in adults. More research is needed to investigate whether they offer added clinical advantages for specific groups of patients with asthma.”

IN THE BAG FOR GPS - a summary of the DTB article on suggested medicines GPs should carry in case of emergency while on home visits and the storage of such medicines.

Many GPs have given up responsibility for out-of-hours services, due to alternative provision by primary care trusts. However, there remains a need for many GPs to carry an appropriately stocked bag for dealing with acute situations when on home visits. So continuing its long-running series on DRUGS FOR THE DOCTOR’S BAG, DTB offers practical suggestions on what should be carried for treating child patients in a range of key clinical scenarios, including the following:

- Asthma and coup
- Infection
- Dehydration
- Diabetic emergencies
- Seizures
- Anaphylaxis
- Acute pain
- Opioid overdose
- Nausea and vomiting
- Hypoadrenalism

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