Other Drugs Included in the Basic Therapy of Bronchial Asthma
In addition to inhalation glucocorticoids, there are also other drugs that are part of the basic therapy for asthma. These are blockers of leukotriene receptors.
Leukotrienes are involved in the pathogenesis of asthma. Together with histamine, they relate to mediators of an allergic reaction of immediate type. Histamine causes a fast and short-term bronchospasm, leukotrienes – stunted and longer bronchospasm.
- Leukotrienes are one of the main mediators of the formation of chronic inflammation of the respiratory tract in patients with asthma. Bronchospasm, which causes leukotrienes, is many times more potent than histamine;
- Leukotrienes cause increased vascular permeability, increased mucus production, increased cellular infiltration of the mucous membrane of the respiratory tract, and bronchial remodeling (change in shape);
- Concrete data show that leukotrienes play an important role in the pathogenesis of asthma and allergic rhinitis.
They cause a spasm of smooth muscles, disrupt mucociliary clearance, increase mucus secretion, attract eosinophils into the airways and improve vascular permeability, which leads to edema formation.
- Antileukotrienes inhibit certain receptors of the epithelium of the respiratory tract, thus possessing simultaneously the ability to inhibit bronchospasm;
- Current guidance from the Global Initiative for Bronchial Asthma (GIBA), a report on the treatment of asthma in children from the PRACTALL project (Practising Allergology) and recommendations from the ARIA (Allergic Rhinitis and its Impact in Asthma) project classify leukotriene blockers as group of drugs that allow you to monitor the course of the disease;
- The numerous studies confirmed the data on the positive effect of antileukotriene drugs in persistent asthma.
Bronchial asthma is often accompanied by rhinitis. In addition, isolated allergic rhinitis increases the risk of developing asthma.
The ARIA report 2007 contains recommendations to use antileukotriene drugs for the treatment of isolated allergic rhinitis, as well as rhinitis, which accompanies asthma.
With a mild allergic rhinitis, these drugs can be used in mono mode.
Antileukotriene drugs (ALTD) include:
- 5-lipoxygenase inhibitors (5-LO, leukotriene biosynthesis): zileuton, used mainly in the USA;
- cysteinyl leukotriene (CysLT1) antagonists: montelukast (Singulair), zafirlukast (Accolate) and pranlukast (Onon), which is used mainly in Japan.
- also, the so-called FLAP inhibitors, which inhibit 5-LO activating proteins, are still being investigated (in clinical practice).
Indications for the appointment of leukotriene receptor antagonists:
- prophylaxis and long-term treatment of asthma, including the prevention of day and night symptoms of the disease in adults and children from 2 years;
- treatment of aspirin-sensitive patients with asthma;
- prevention of bronchospasm caused by physical loads;
- the possibility of using drugs from the group of leukotriene receptor inhibitors in combination with any basic drug, as well as the possibility of using them
- as monotherapy with a mild persistent form of asthma in children;
blockage of day and night symptoms of seasonal allergic rhinitis (in adults and children from 2 years of age) and persistent allergic rhinitis (in adults and
- children from 2 years of age).
Data on the benefits of ALTD for asthma exacerbation is extremely small.
Small studies have shown an improvement in peak expiratory flow rate (but the level of evidence is only C), and therefore an assessment of the clinical significance requires additional studies.
Currently, the role of antileukotriene drugs in the treatment of asthma has been proven by a large number of studies. According to international conciliation documents, leukotriene receptor antagonists are used from the first stage of therapy as monotherapy or from the 2nd stage of therapy in combination with inhalation glucocorticoids.
According to international recommendations, leukotriene receptor antagonists are used from the first stage of therapy as monotherapy or from the second stage of therapy in combination with inhalation glucocorticoids.
The most often appointed preparation is Montelukast (Singular).
But these drugs, most often remain a second-line therapy.
Preparations of the FIRST line, still are inhalation glucocorticoids, which are more preferable than leukotriene receptor blockers. You can not replace any steroids with antileukotriene drugs.
“PRACTALL” (Practicing Allergology) recommends the use of montelukast (Singulair) for mild asthma, especially if it is a virus-induced one.
The drug is taken orally 1 time / day, regardless of food intake.
For the treatment of bronchial asthma, montelukast should be taken in the evening. In the treatment of allergic rhinitis, the drug can be taken at any time of the day.
With a combined pathology (bronchial asthma and allergic rhinitis), the drug should be taken in the evening.
Antileukotriene drugs have anti-inflammatory and bronchodilating effect, have a high safety profile, and the action of standard therapy to improve asthma control.
These drugs have a quick effect and are easy to apply. The use of antileukotriene drugs allows you to personalize therapy (with different phenotypes of asthma.
- Antileukotriene drugs relieve the symptoms of asthma and are the drugs for the basic therapy of this disease, especially when combined with inhalation glucocorticoids.
- Montelukast is recommended for patients suffering from asthma with concomitant allergic rhinitis.
- Positively affects the treatment of aspirin-sensitive patients with asthma.
- Leukotriene receptor antagonists are included as monotherapy in children with mild persistent asthma, especially if it is virus-induced (evidence-based medicine).
- Antileukotriene drugs lead to a significant improvement in the control of asthma in children (including children 2-5 years).
- Reduce the frequency of exacerbations of asthma caused by a viral infection in children aged 2-5 years with intermittent asthma.
- Blockers of leukotriene receptors prevent bronchospasm caused by physical exertion or cold air.