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(Chest. 2005;128:2954-2962.)
© 2005 American College of Chest Physicians

Long-Acting Bronchodilator or Leukotriene Modifier as Add-on Therapy to Inhaled Corticosteroids in Persistent Asthma?*

Graeme P. Currie, MD; Daniel K. C. Lee, MD and Prasima Srivastava, MD

* From the Department of Respiratory Medicine (Drs. Currie and Srivastava), Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland; and Department of Respiratory Medicine (Dr. Lee), Ipswich Hospital, Ipswich, England, UK.

Correspondence to: Graeme P Currie, MD, Department of Respiratory Medicine, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN Scotland, UK; e-mail: graeme.currie{at}nhs.net

Despite the widespread use of inhaled corticosteroids, many asthmatic patients experience persistent symptoms. In such individuals, the addition of a long-acting ß2-agonist (LABA) is frequently more effective than doubling the dose of inhaled corticosteroid. However, the role of additional therapy with a leukotriene receptor antagonist (LTRA) as an alternative to an LABA has been the focus of attention in recent studies. In order to determine the overall efficacy of the pharmacologic armamentarium used in asthma, it is imperative that a combination of end points, including lung function, airway hyperresponsiveness, effects on underlying inflammation, symptoms, and more long-term sequelae such as exacerbations, are assessed. This evidence-based systematic review outlines the pharmacologic properties of LABAs and LTRAs and the importance of evaluating end points in addition to lung function when assessing these drugs. We also highlight the results of all published studies that have performed direct comparisons of both LABAs and LTRAs as add-on therapy to inhaled corticosteroids.

Key Words: asthma • formoterol • inflammation • leukotriene receptor antagonist • long-acting ß2-agonist • montelukast • salmeterol • zafirlukast




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