To provide a comprehensive review of studies that evaluate the effects of leukotriene receptor antagonists in adult chronic asthma.
A literature search using MEDLINE, Clinical Evidence, and the Cochrane Library was performed using the following keywords: randomized controlled trial, asthma, cysteinyl leukotriene, leukotriene receptor antagonist, antileukotriene, montelukast, zafirlukast, pranlukast, inflammation, lung function, exacerbations, and symptoms.
Relevant peer-reviewed articles (mostly randomized controlled trials, meta-analyses, and reviews) published up to July 2006 were selected and extracted.
Leukotriene receptor antagonists are beneficial across a range of asthma severities and may have a particular role in exercise-induced asthma, aspirin-sensitive asthma, and individuals with concomitant allergic rhinitis.
In the management of chronic asthma, leukotriene receptor antagonists have emerged as a useful oral nonsteroidal anti-inflammatory adjunct both as monotherapy and in combination with other classes of drugs. Monitoring their effects in terms of lung function alone may result in clinicians missing beneficial effects on inflammatory biomarkers, airway hyperresponsiveness, and exacerbations.
"It is used as the sodium salt, but doses are expressed in terms of the base; montelukast sodium 10.38 mg is equivalent to about 10 mg of montelukast. In the management of chronic asthma (Currie and McLaughlin 2006) and as prophylaxis for exercise-induced asthma, montelukast sodium is given in doses equivalent to 10 mg of montelukast once daily in the evening. It should not be used to treat an acute asthma attack. "
[Show abstract][Hide abstract] ABSTRACT: Simple, sensitive and accurate stability indicating analytical method for montelukast has been developed and validated by using RP-HPLC techniques and applying the proposed method in the assay of Montelukast ® tablets (SIGMA Pharmaceuticals), since there is no official monograph. The procedure was developed and validated under acidic, basic, oxidative and photo-irradiation conditions. Chromatography was performed with mobile phase containing a mixture of acetonitrile and 0.01M potassium dihydrogen phosphate buffer pH 4.0 (7:3 v/v) with flow rate of 1.0 mL per min, C 18 column and UV detection at 355 nm. developed method satisfies the system suitability criteria, peak integrity, and resolution for the parent drug and its degradants. The method was validated for linearity (correlation coefficient = 0.9999), accuracy, and precision. Experimental design was used for validation of robustness and intermediate precision. The proposed method was simple, highly sensitive, precise and accurate. And the run time was less than 15 min which indicates the method is useful for routine quality control analysis and stability testing. Montelukast was determined to be more sensitive to the acidic conditions and photodegradation on light exposure, oxidation may also appear. But it was stable in alkaline medium.
[Show abstract][Hide abstract] ABSTRACT: Montelukast sodium (Singulair, Merck and Co., Inc., Whitehouse Station, NJ) is a selective and orally-active leukotriene receptor antagonist with demonstrated effectiveness for treating allergic asthma and allergic rhinitis in adults and children as young as 12 months of age for allergic asthma and 6 months of age for allergic rhinitis. It was recently approved in the US for prevention of exercise-induced bronchoconstriction in patients who are > or = 15 years of age. This paper updates a prior review of the data on the clinical efficacy of montelukast published in this journal.
[Show abstract][Hide abstract] ABSTRACT: To investigate the prevalence in adults of pharyngeal and laryngeal symptoms associated with the use of inhaled corticosteroids.
Prospective, observational and based on a structured, specifically designed postal questionnaire.
University Hospital Aintree, Liverpool, UK.
The questionnaire was distributed to 190 patients on the basis of current inhaled corticosteroid use. Recruitment was from the databases of two local general practices. Individuals were classified as mild, moderate or severe asthmatics, using the guidelines of the British Thoracic Society.
Demographic data, including smoking history, were recorded. The number, type, strength, dosing regime and duration of individual inhaler use were recorded. Specific pharyngeal and laryngeal side effects were enquired about. Co-morbidities and preventive measures were also recorded. Results were analysed using univariate and multivariate statistical tests.
There was a 75.8 per cent response rate (144/190 questionnaires); 63 (43.8 per cent) of respondents were male and 81 (56.2 per cent) were female. The majority of our patients were either mild or moderate asthmatics. Longer use of an inhaled corticosteroid predisposed to weak voice (p = 0.0016), hoarseness (p = 0.0001) and throat irritation (p = 0.008). Hoarseness, throat irritation, sore throat and cough were observed much more frequently than anticipated. Severe asthmatics were more likely to use a spacer device compliantly (p = 0.0487; odds ratio 1.53). Side effects were more prevalent as asthma severity worsened (p = 0.0049; odds ratio 1.87).
Inhaled corticosteroids cause sore throats, throat irritation, hoarseness and cough. Further research in this area is required in order to elucidate the mechanism of inflammation. Only then can effective preventive measures be introduced and implemented.
The Journal of Laryngology & Otology 02/2008; 122(10):1078-83. DOI:10.1017/S0022215107001272 · 0.67 Impact Factor
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