“Pragmatic” Approach an Option for Asthma Treatment

An inhaled glucocorticoid is the preferred first step in asthma treatment, but another medication that is available in pill form could be as effective and easier to take. (Image: Ted Grudzinski/©AMA)

In rigorous randomized controlled trials, inhaled glucocorticoids emerged as the preferred first step in treating asthma. But in the real world, where patients do not meet strict research criteria, new research shows that leukotriene-receptor antagonists (LTRAs) may be just as effective as first-line treatment.

The study, released online today in the New England Journal of Medicine, was conducted with patients treated in primary care settings. These types of “pragmatic” studies have limitations. But some experts say they can help physicians and patients make practical, individualized treatment decisions.

Researchers in the United Kingdom evaluated 2 groups of patients with asthma. In the first group, 148 patients took LTRAs and 158 used inhaled glucocorticoids as first-line therapy. In the second group, patients took inhaled glucocorticoids but needed additional treatment. LTRAs were given to 170 patients and 182 received a long-acting Β2-agonist (LABA), which is the recommended supplemental medication.

After 2 months of treatment, patient scores on a questionnaire about asthma-related symptoms and quality of life indicated that LTRA therapy was as effective as an inhaled glucocorticoid for first-line treatment and as effective as a LABA as a supplemental treatment. After 2 years, although LTRAs did not produce results equivalent to those of inhaled glucocorticoids, the study authors said there was “little difference.”

An accompanying editorial noted that taking LTRA pills is easier than using an inhaler; participants who received LTRAs were more likely than participants who received inhaled glucocorticoids to reliably take their medication. Generic versions of the antileukotrienes montelukast and zafirlukast are expected soon, offering cost advantages.

The editorial also noted that patients with asthma often have a congested, runny nose or other related conditions that LTRAs may relieve. Even though LTRAs target a single molecule (leukotriene), they reduce both airway-narrowing bronchospasm and inflammation. Antihistamines added to LTRAs can offer additional benefits.

“Selective oral medications that block a few key molecules may provide effective and patient-friendly treatments,” the editorial authors said.

Categories: Asthma, Evidence-Based Medicine, Pulmonary Diseases