Leukotrienes modifiers

Step 2 Mild persistent Daytime Symptoms leukotriene modifier or theophylline ... 

Greater than 2 times per month Cromolyn, leukotriene modifiers, without facemask or DPI)... 

In persistent asthma, inhaled corticosteroids provide the most comprehensive control of the inflammatory process and are the cornerstone of therapy.2 Inhaled corticosteroids are more effective than cromolyn, leukotriene modifiers, nedocromil, and theophylline in reducing markers of inflammation and AHR, improving lung function, and preventing emergency department visits and hospitalizations due to asthma exacerbations.2,25 The primary... 

Leukotriene modifiers either inhibit 5-lipoxygenase (zileuton) or competitively antagonize the effects of leukotriene D4 (montelukast and zafirlukast). These agents improve FEV, and decrease asthma symptoms, rescue drug use, and exacerbations due to asthma. Although these agents offer the convenience of oral therapy for asthma, they are significantly less effective than low doses of inhaled corticosteroids.2,33... 

Leukotriene modifiers (e.g., zafirlukast and montelukast) have not been adequately evaluated in COPD patients and are not recommended for routine use. Small, short-term studies showed improvement in pulmonary function, dyspnea, and quality of life when leukotriene modifiers were added on to inhaled bronchodilator therapy.27,28 Additional long-term studies are needed to clarify their role. 

Antihistamines and intranasal corticosteroids are considered first-line therapy for allergic rhinitis, whereas decongestants, mast cell stabilizers, leukotriene modifiers, and systemic corticosteroids are secondary treatment options. 

Pharmacotherapy has an important role in managing AR symptoms (Table 59-2). Intranasal corticosteroids, systemic and topical antihistamines and decongestants, mast cell stabilizers, and immunotherapy all are beneficial in treating symptoms of AR.9 Antihistamines and intranasal corticosteroids are considered first-line therapy for AR, whereas decongestants, mast cell stabilizers, leukotriene modifiers, and systemic corticosteroids are secondary treatment options10-12 (Fig. 59-2). Whenever exposure to allergens can be predicted (e.g., SAR or visiting homes with a pet), medications should be used pro-phylactically to maximize effectiveness.11... 

Leukotrien Modifiers Indications No specific adverse effects... 

Leukotriene modifier Medium or high dose ICS Leukotriene modifier Anti-lgE treatment... 

Low dose ICS Leukotriene modifier Sustained release Theophylline ... 

Although they remain less effective than inhaled corticosteroids, a 5-LOX inhibitor (zileuton) and selective antagonists of the CysLTl receptor for leukotrienes (zafirlukast, montelukast, and pranlukast see Chapter 20) are used clinically in mild to moderate asthma. Growing evidence for a role of the leukotrienes in cardiovascular disease has expanded the potential clinical applications of leukotriene modifiers. Conflicting data have been reported in animal studies depending on the disease model used and the molecular target (5-LOX versus FLAP). Human genetic studies have demonstrated a link between cardiovascular disease and polymorphisms in the leukotriene biosynthetic enzymes, in particular FLAP, in some populations. 

Capra V, Rovati GE. Leukotriene modifiers in asthma management. IDrugs. 2004 7 659-666. 

Kemp JP. Recent advances in the management of asthma using leukotriene modifiers. Am J Respir Med. 2003 2 139-156. 

Biochemical pathways of the formation and action of leukotrienes and sites of action of leukotriene-modifying drugs. 

Effects of leukotriene modifiers in patients with chronic persistent asthma. PEFR = peak expiratory flow rate. 

Currie GP, Lee DK, Srivastava P (2005) Long-acting bronchodilator or leukotriene modifier as add-on therapy to inhaled corticosteroids in persistent asthma Chest 128 2954-2962. 

Leukotriene (LK) Leukotriene is the primary bronchoconstrictor. This increases migration of eosinophil, increases mucous production and increases edema in the bronchi, resulting in bronchoconstriction. There are two types of leukotriene modifiers LT receptor antagonists and LT synthesis inhibitors. Both reduce inflammatory symptoms of asthma. Leukotriene modifiers include ... 

---