Additive effect of cysteinyl leukotriene or thromboxane modifiers to inhaled corticosteroids in asthmatic patients

Abstract

Bronchial asthma is a chronic inflammatory disease of the conducting airways. Current asthma treatment guidelines recommend inhaled corticosteroids (ICS) as the first-line maintenance therapy for mild to severe persistent asthma, because ICS are the most efficacious anti-inflammatory medication. Despite treatment with ICS, suppression of inflammation is often incomplete and blockade by ICS of cysteinyl leukotriene (CysLT) and thromboxane (TX) A2 biosynthesis is limited. The addition of a CysLT1 receptor antagonist to an ICS represents a reasonable alternative therapeutic approach for the treatment of asthma patients whose symptoms remain uncontrolled on ICS alone. Indeed, CysLT1 receptor antagonists are demonstrated both to have an additive effect to ICS therapy and to allow the reduction of ICS dosage. Thromboxane modifiers also have an additive effect with low- to moderate-dose ICS. Although the long-term usefulness of add-on therapy of CysLT or TX modifiers (vs long-acting β2-adrenergic receptor agonists) to ICS is unclear, these alternatives are worthy of further consideration.

Keywords

• asthma
• corticosteroid
• cysteinyl leukotriene
• thromboxane