Addition of Leukotriene Receptor Antagonists to Inhaled Corticosteroids Improved QOL of Patients with Bronchial Asthma Surveyed in Suburban Tokyo, Japan

Ohshima, Nobuharu; Matsui, Hirotoshi; Matsui, Yoshinori; Kawashima, Masahiro; Shimada, Masahiro; Higaki, Naoko; Shoji, Shunsuke; Wada, Hiroo; Fujita, Akira; Watanabe, Hidehiro; Yamaguchi, Norio; Matsuoka, Rokuro; Oki, Kazuhiko; Takahashi, Hisaho; Suzuki, Michiaki; Yamazaki, Haruki; Yoshizawa, Masafumi; Goto, Hajime

doi:10.2332/allergolint.10-oa-0296

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…RCTs have confirmed the efficacy of leukotriene receptor antagonists (LTRAs) when added to ICSs in improving symptoms, lung function, quality of life, as well as asthma-related hospitalizations and mortality. 92 – 95 Yasui et al 96 showed that additional administration of oral pranlukast to ICSs in stable asthmatics provided additional clinical benefit. Interestingly, add-on oral pranlukast was found to significantly reduce the levels of alveolar nitric oxide, suggesting that the clinical benefit of oral pranlukast could be mediated by the reduction in peripheral airway inflammation.…”

Section: Long-acting β2 Agonistsmentioning

confidence: 99%

The use of ICS/LABA (extra-fine and non-extra-fine) in elderly asthmatics

Benfante

Basile

Battaglia

et al. 2016

TCRM

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Age represents an exclusion criterion in randomized clinical trials designed to test the efficacy and safety of inhaled drugs in asthma. As a consequence, data on efficacy and safety of inhaled corticosteroid (ICS) and long-acting β2 agonist (LABA) combinations in elderly asthmatics are scanty. Older age is associated with an increased proportion of comorbid conditions; in addition, all organ functions undergo a process of senescence, thus reducing their ability to metabolize the agents. Overall, these age-associated conditions may variably, and often unpredictably, affect the metabolism and excretion of respiratory drugs. However, pharmacological treatment of asthma does not follow specific recommendations in the elderly. In the elderly, the ICS/LABA combinations may carry an increased risk of local indesiderable effects, primarily due to the lack of coordination between activation of the device and inhalation, and systemic adverse events, mainly due to the greater amount of active drug that is available because of the age-associated changes in organ functions as well as drug-to-drug and drug-to-concomitant disease interactions. The extra-fine formulations of ICSs/LABAs, which allow for a more favorable drug deposition in the lungs at a reduced dose, may contribute to overcome this issue. This review revises the efficacy and safety of treatment with ICSs/LABAs, focusing on the main pharmacodynamic and pharmacokinetic properties of the drugs and highlighting the potential risks in the elderly asthmatic population.

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Section: Long-acting β2 Agonistsmentioning

confidence: 99%

The use of ICS/LABA (extra-fine and non-extra-fine) in elderly asthmatics

Benfante

Basile

Battaglia

et al. 2016

TCRM

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“…Randomized controlled trials have confirmed the efficacy of LTRAs when used as monotherapy or added to inhaled corticosteroids for improving asthma outcomes, including lung function, symptoms, asthma exacerbations, health-related quality of life, rates of hospitalization, and death due to asthma attacks 21–24. In a recent study, Yasui et al25 showed that addition of oral pranlukast to an inhaled corticosteroid or an inhaled corticosteroid plus a long-acting beta-2 adrenergic agent in stable asthmatics provided additional clinical benefit.…”

Section: Contribution Of Leukotriene Modifiers To Asthma Treatmentmentioning

confidence: 99%

Safety and efficacy of montelukast as adjunctive therapy for treatment of asthma in elderly patients

Scichilone¹,

Battaglia²,

Benfante³

et al. 2013

CIA

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Asthma is a disease of all ages. This assumption has been challenged in the past, because of several cultural and scientific biases. A large body of evidence has accumulated in recent years to confirm that the prevalence of asthma in the most advanced ages is similar to that in younger ages. Asthma in the elderly may show similar functional and clinical characteristics to that occurring in young adults, although the frequent coexistence of comorbid conditions in older patients, together with age-associated changes in the human lung, may lead to more severe forms of the disease. Management of asthma in the elderly follows specific guidelines that apply to all ages, although most behaviors are pure extrapolation of what has been tested in young ages. In fact, age has always represented an exclusion criterion for eligibility to clinical trials. This review focuses specifically on the safety and efficacy of leukotriene modifiers, which represent a valid option in the treatment of allergic asthma, both as an alternative to first-line drugs and as add-on treatment to inhaled corticosteroids. Available studies specifically addressing the role of montelukast in the elderly are scarce; however, leukotriene modifiers have been demonstrated to be safe in this age group, even though cases of acute hepatitis and occurrence of Churg-Strauss syndrome have been described in elderly patients; whether this is associated with age is to be confirmed. Furthermore, leukotriene modifiers provide additional benefit when added to regular maintenance therapy, not differently from young asthmatics. In elderly patients, the simpler route of administration of leukotriene modifiers, compared with the inhaled agents, could represent a more effective strategy in improving the outcomes of asthma therapy, given that unintentional nonadherence with inhalation therapy represents a complex problem that may lead to significant impairment of asthma symptom control.

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“…Unfortunately, not all GPs adhere to these guidelines [8]. In fact, evidence suggests under-treatment of asthmatics by Japanese physicians [9], and some studies have reported that GPs lag behind RS with regard to the management of asthma [8,10,11].…”

Section: Introductionmentioning

confidence: 99%

Comparison of clinical management of young and elderly asthmatics by respiratory specialists and general practitioners

Tada¹,

Kuraki²,

Taooka³

et al. 2014

Journal of Asthma

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Addition of Leukotriene Receptor Antagonists to Inhaled Corticosteroids Improved QOL of Patients with Bronchial Asthma Surveyed in Suburban Tokyo, Japan

Abstract: These results suggest that the frequency of visits to an emergency room was decreased by complementing the anti-inflammatory effect of ICS with further treatment of inflammation, particularly with LTRA.

Cited by 5 publications

References 14 publications

The use of ICS/LABA (extra-fine and non-extra-fine) in elderly asthmatics

The use of ICS/LABA (extra-fine and non-extra-fine) in elderly asthmatics

Safety and efficacy of montelukast as adjunctive therapy for treatment of asthma in elderly patients

Comparison of clinical management of young and elderly asthmatics by respiratory specialists and general practitioners

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