Leukotriene antagonist prevents exacerbation of asthma during reduction of high-dose inhaled corticosteroid. The Tokyo Joshi-Idai Asthma Research Group.

Abstract

To test whether the leukotriene antagonist ONO-1078 (pranlukast) prevents asthma exacerbations during reduction of high-dose inhaled corticosteroid, we conducted a randomized, double-blind, placebo-controlled study in 79 asthma patients requiring high doses (1,500 microg/d or more) of inhaled beclomethasone dipropionate (BDI) for clinical control (duration of asthma, 11.0 +/- 3.1 yr; duration of BDI treatment, 0.5 +/- 0.3 yr; FEV1 percentage of predicted, 80.7 +/- 2.0%). After a 2-wk run-in period, the doses of BDI were halved, while the patients were assigned to receive orally ONO-1078, 450 mg twice daily, or placebo. In the placebo group FEV1 decreased by 0.33 +/- 0.20 L after 6 wk (p < 0.001). Likewise, morning and evening PEF decreased by 46 +/- 7 L/min and 18 +/- 6 L/min, respectively. By contrast these variables were sustained above baseline in the ONO-1078 group. The number of daytime and nighttime asthma symptoms and the use of beta2-agonist increased in the placebo group, whereas they remained unchanged in the ONO-1078 group. In the placebo group concentrations of serum eosinophil cationic protein and exhaled nitric oxide increased (p = 0.007 and p = 0.025, respectively), compared with no change in the ONO-1078 group. Therefore, the leukotriene antagonist ONO-1078 prevents the asthma deterioration provoked by a 6-wk reduction of the dose of inhaled BDI into half.

What is the future for inhaled steroids in adult asthma care?

“…Several shortterm studies suggest that many patients can achieve large reductions in inhaled steroid dosage without asthma control deteriorating. [5][6][7] A major concern is whether the dose of inhaled steroid can be reduced in the long-term with the same effect. Furthermore, greater use of oral corticosteroids to treat exacerbations may override any attempt to minimise steroid-induced side-effects by the reduction of inhaled steroids.…”

“…[1][2][3][4][5][6] Guidelines for the management of chronic obstructive pulmonary disease (COPD) have also been published, [6][7][8][9][10][11][12][13] but these are mainly drawn up by thoracic societies and some parts are less relevant for patients with milder forms of COPD or those treated in primary care. The aim of this paper is to provide recommendations (evidence-based where possible) to guide primary care professionals in their management of adult patients with COPD.…”

“…Only guidelines for the managment of COPD which were published in English were selected. Only 10 publications met these criteria [6][7][8][9][10][11][12][13][14][15][16] and none of them were specifically aimed at patients treated in primary care. Based on these publications and on the consensus of the authors, the following guidelines for the management of mild to moderate COPD in primary care are suggested.…”

“…In this respect there are significant differences between COPD and asthma that have obvious consequences for treatment. 6 COPD is a generic term for chronic bronchitis, emphysema and a disorder of the peripheral airways, of which chronic progressive irreversible airflow obstruction is the…”

Asthma in children: classification and treatment

“…Estudos recentes com montelucaste em crianças têm demonstrado efeito similar ao de baixas doses de glicocorticosteróide inalado, acompanhado por melhora na qualidade de vida, redução no consumo de medicação de alívio, maior estabilização do pico de fluxo expiratório, redução da eosinofilia em sangue periférico e em escarro induzido por inalação de salina hipertônica (possível ação antiinflamatória ?) 75,76 . Segundo o II Consenso Brasileiro no manejo da Asma, os leucotrienos têm sido recomendado para crianças portadoras de asma leve/moderada 1 .…”