Greater Role for Leukotriene-Receptor Antagonists in Asthma?

NIH asthma guidelines recommend inhaled corticosteroids (ICS) as first-line treatment for patients who have mild persistent asthma, with addition of a long-acting β-agonist (LABA) for uncontrolled symptoms. Previous double-blind randomized trials — conducted with tightly managed methodology — typically showed that ICS and LABAs were superior to leukotriene-receptor antagonists (LTRAs) for those indications. Now, two open-label randomized pragmatic U.K. studies provide a real-world perspective.

In one study, 300 treatment-naive asthma patients received oral LTRAs (montelukast [Singulair] or zafirlukast [Accolate and generics]) or ICS (beclomethasone, budesonide, or fluticasone). In the other study, 350 patients with uncontrolled symptoms who …