The Pharmaceutical Journal
Vol 270 No 7242 p429
29 March 2003

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Inhaled drugs better than oral therapy

Inhaled glucocorticoid drugs are more effective than the newer anti-leukotriene tablets for adults with mild or moderate asthma, according to a review by a Canadian researcher.

Professor Francine Ducharme, from Montreal Children’s Hospital, reviewed 13 trials comparing leukotriene receptor antagonist (LRA) monotherapy with low doses of inhaled glucocorticoids in children and adults with mild or moderate asthma.

Adults treated with LRAs were 60 per cent more likely to suffer worsening of symptoms needing systemic steroids, whereas those treated with inhaled glucocorticoids experienced fewer night awakenings and fewer days with symptoms.

Professor Ducharme said that there was insufficient evidence to draw conclusions about the use of LRAs as monotherapy in children.

She concluded that, at present, the scientific evidence does not support the substitution of LRAs for inhaled glucocorticoids (BMJ 2003;326:621).

LRAs have been included in new asthma treatment guidelines (PJ, 1 February, p141). These agents are recommended as options for add-on therapy if the first-line add-on drug (a long-acting b₂-agonist) or increased steroid dose are not effective. The guidelines also include LRAs as a fourth drug for patients with persistent poor control (Step 4 therapy).