Effects of montelukast and beclomethasone on airway function and asthma control

Israel, Elliot; Chervinsky, Paul; Friedman, Bruce; Bavel, Julius van; Skalky, Carol S.; Ghannam, Asma F.; Bird, Steven R.; Edelman, Jonathan M.

doi:10.1067/mai.2002.129413

Cited by 98 publications

(69 citation statements)

References 20 publications

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“…However, LTRA do not provide as good a benefit as low-dose inhaled CS therapy [115,116] although they remain an alternative therapy, particularly in pediatric patients. One study indicated that the intermittent use of ICS combined with a short-acting β-agonist (SABA) as needed was as effective as the regular use of ICS twice daily with SABA as needed [117].…”

Section: Mild Persistent Asthmamentioning

confidence: 99%

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Chung

Caramori

Adcock

2009

Eur J Clin Pharmacol

121

106

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International audienceInhaled corticosteroid (ICS) therapy in combination with long-acting β-adrenergic agonists represents the most important treatment for chronic airways diseases such as asthma and chronic obstructive pulmonary disease (COPD). ICS therapy forms the basis for treatment of asthma of all severities, improving asthma control, lung function and preventing exacerbations of disease. Use of ICS has also been established in the treatment of COPD, particularly symptomatic patients, who experience useful gains in quality of life, likely from an improvement in symptoms such as breathlessness and in reduction in exacerbations, and an attenuation of the yearly rate of deterioration in lung function. The addition of long-acting β-agonist (LABA) therapy with ICS increases the efficacy of ICS effects in moderate-to-severe asthma. Thus, a 800 μg daily dose of the ICS budesonide reduced severe exacerbation rates by 49% compared to a low dose of 200 μg daily, and addition of the LABA formoterol to budesonide (800 μg) led to a 63% reduction. In COPD, the effects of ICS are less prominent but there are beneficial effects on the decline in FEV and the rate of exacerbations. A reduction in the rate of decline in FEV of 16 ml/year with a 25% reduction in exacerbation rate has been reported with the salmeterol and fluticasone combination. A non-significant 17.5% reduction in all-cause mortality rate with ICS and LABA is reported. Chronic inflammation is a feature of both asthma and COPD, although there are site and characteristic differences. ICS targets this inflammation although this effect of ICS is less effective in patients with severe asthma and with COPD; however, addition of LABA may potentiate the anti-inflammatory effects of ICS. An important consideration is the presence of corticosteroid insensitivity in these patients. Currently available ICS have variably potent binding activities to specific glucocorticoid receptors, leading to inhibition of gene expression by either binding to DNA and inducing anti-inflammatory genes or by repressing the induction of pro-inflammatory mediators. Local side effects of ICS include oral candidiasis, hoarseness and dysphonia, while systemic side effects, such as easy bruising and reduction in growth velocity or bone mineral densitometry, are usually restricted to doses above maximally recommended doses. Use of LABA alone in patients with asthma increases the risk of asthma-related events including deaths, but this is less observed with the combination of ICS and LABA. Therefore, use of LABA alone is not recommended for asthma therapy. Future progress in ICS development will be characterised by the introduction of ICS with greater efficacy with a limited side-effect profile, and by longer-acting ICS that can be used in combination with once-daily LABAs. Other agents that could improve the efficacy of corticosteroids or reverse corticosteroid insensitivity may be added to ICS. ICS in combination with LABAs will continue to remain the main focus of treatment of airways diseases

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Section: Mild Persistent Asthmamentioning

confidence: 99%

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Chung

Caramori

Adcock

2009

Eur J Clin Pharmacol

121

106

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“…In contrast to this clinical profile, LTRAs have antiinflammatory properties as judged by suppression of markers of airway inflammation in asthma, even in subjects previously treated with combination therapy (8,9). Furthermore, in some reports, these agents have been shown to reduce asthma exacerbations to a degree comparable to an ICS, although ICS produce superior effects on lung function (10,11). In this regard, because the elements of asthma control achieved by an LTRA (suppression of inflammation and maintenance of control) and an LABA (improvement in lung function) appear to be complementary, we hypothesized that the combination of an LTRA and an LABA might demonstrate synergistic beneficial clinical properties and thus provide an effective therapeutic strategy for asthma.…”

Section: What This Study Adds To the Fieldmentioning

confidence: 97%

Combination Therapy with a Long-Acting β-Agonist and a Leukotriene Antagonist in Moderate Asthma

Deykin

Wechsler

Boushey

et al. 2007

Am J Respir Crit Care Med

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“…19 Neither treatment group differed in measures of clinical effectiveness, including reduction in beta-agonist use or the need for oral corticosteroids, and they did not differ in the extent of sustained asthma relief. It was therefore surprising that these authors identified that both montelukast and inhaled BDP differed in their effects on airway function, as can be seen in Figure 6.…”

Section: From Asthma Severity To Asthma Control: Identification Of Nementioning

confidence: 99%

“…19 This was a randomized, multicenter, double-blind, placebo-controlled, parallel-group study of asthmatics (n = 782) defined as having (1) an FEV1 percent predicted value between 50% and 85% at rest, and at least a 15% increase in FEV1 after albuterol administration; (2) a weekly average beta-agonist use of >2 puffs/day; and (3) an age span between 15 and 85 years. Additionally, patients had to have had at least a 1-year history of clinical asthma symptoms and be nonsmokers.…”

Section: From Asthma Severity To Asthma Control: Identification Of Nementioning

confidence: 99%

From Asthma Severity to Asthma Control: Identification of New Guidelines

Jones

Endicott²,

Kaufman³

2006

JMCP

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Effects of montelukast and beclomethasone on airway function and asthma control

Cited by 98 publications

References 20 publications

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Combination Therapy with a Long-Acting β-Agonist and a Leukotriene Antagonist in Moderate Asthma

From Asthma Severity to Asthma Control: Identification of New Guidelines

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