India has a large
population of patients with chronic respiratory
diseases. More than 15 million are
believed to suffer from asthma alone in India.
Asthma is defined as an
inflammatory disorder of the airways. It causes attacks of wheezing, shortness of breath, chest tightness, and coughing.
It inflames and narrows
Most asthma medications
work by relaxing airways (bronchodilators) or reducing inflammation
(corticosteroids). Inhaled medications are generally preferred over tablet or
liquid medicines. These act directly on the airway surface and airway muscles;
they also produce the least side effects.
Inhaled drugs include
• Beta-2 agonists,
• Corticosteroids, and
Apart from these, oral
medications are available. These include: Aminophylline, leukotriene
antagonists (LTRA), beta-2
agonists (e.g. long-acting beta2
-agonist), and corticosteroid tablets
Asthma treatment guidelines recommend inhaled
glucocorticoids as the first-line controller medication for asthma control in
patients with mild persistent asthma. A
recent trial evaluate the real-world effectiveness of a leukotriene-receptor
antagonist (LTRA) as compared with either an inhaled glucocorticoid for
first-line asthma-controller therapy
or a long-acting beta2
(LABA) as add-on therapy in patients already receiving inhaled glucocorticoid
Two parallel, multicenter, pragmatic trials were
performed. Results were published in the New England Journal of Medicine
, a leading medical journal. Study results
at 2 months suggest that LTRA was
equivalent to an inhaled glucocorticoid as first-line controller therapy and to
LABA as add-on therapy for diverse primary care patients.
LTRAs are more expensive
than steroid inhalers. But this scenario could easily change with its increase
use and LTRA drugs like montelukast and zafirlukast can soon be marketed at a
lower price. The new findings bring out increased options in the management of
first time diagnosed asthmatics with better long term compliance.
With these findings the researchers urge general practitioners to
consider switching asthma patients from long-acting beta-agonist inhalers to
oral leukotriene-receptor antagonist treatment. Authors say that 'LTRAs are easy to use and can help patients control their
asthma effectively and improve their quality of life'.
The New England Journal of Medicine