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

Abstract

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.

Role of Montelukast in Asthma and Allergic rhinitis patients

“…17 These comprise of two main groups of CysLT1R antagonist (like montelukast, pranlukast, and zafirlukast) and 5-lipoxygenase inhibitors (like zileuton). 18 As far as AR is concerned, montelukast maintains the balance in nitric oxide production, imbalance of which is believed to be one of the contributors in AR pathogenesis. 16 As computed in our results, other authors have also demonstrated a good role of LT receptor antagonists in the management of asthma and AR symptoms.…”

Montelukast-Induced Adverse Drug Reactions: A Review of Case Reports in the Literature

“…Safety data provided by clinical trials highlight no substantial difference in AEs to placebo. The most common AEs observed in these trials were: headache, gastrointestinal disorders, fatigue, pharyngitis, upper respiratory tract infection and rash [65,66,67]. However, clinical trials are often conducted in highly selective patient subgroups, this must be taken into account when drawing conclusions from the SPC of montelukast.…”

Cysteinyl Leukotriene Receptor-1 Antagonists as Modulators of Innate Immune Cell Function

“…There have been relatively few studies of cysLTR1 antagonists in the elderly with asthma. However, what studies there are have suggested that these agents, particularly montelukast, are effective even in the elderly with severe asthma and appear overall to have equivalent benefit as add-on therapy to regular maintenance treatment as compared to younger patients [ 97 , 98 ]. One problem with asthma treatment in the elderly is low adherence to therapy, and the easier route of administration of montelukast (oral agent versus inhaler) could be associated with improvement in overall treatment.…”