Montelukast in pediatric asthma management

Walia, Mandeep; Lodha, Rakesh; Kabra, S. K.

doi:10.1007/bf02825818

“…[13][14][15] The main effects of Cys-LT on airways can be seen in The effects of LTA are the opposite of those described for LT: LTA improve peripheral airway obstruction assessed by pulmonary volumes, air trapping, 16 airway resistance, specific conductance 17 and oscillometry. 18 They reduce the number of eosinophils in induced sputum 19 and in peripheral blood of asthmatic patients.…”

Section: What Do Treatment Guidelines Recommend?mentioning

confidence: 99%

“…These two types of LT act through two different specific receptors. 13 The activity of phospholipase on cell membrane phospholipids initiates a mediator cascade, as shown in Figure 1.…”

Section: What Do Treatment Guidelines Recommend?mentioning

confidence: 99%

“…There are no studies assessing risks and benefits in those situations. 13 Becker et al performed a study comparing the effects of montelukast and beclomethasone on growth of asthmatic school children. They verified reduction in growth rate caused by beclomethasone, whereas the group receiving montelukast did not present such changes.…”

Section: Lta Doses and Side Effectsmentioning

confidence: 99%

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Antileucotrienos no tratamento da asma e rinite alérgica

Ribeiro¹,

Toro²,

Baracat³

2006

J. Pediatr. (Rio J.)

1

0

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Objective: To compare leukotriene antagonists (LTA) to other groups of drugs used in asthma and allergic rhinitis treatment.Sources: MEDLINE, LILACS and Cochrane Library. Keywords: leukotrienes, antileukotrienes, asthma treatment, allergic rhinitis treatment, asthma and allergic rhinitis. An attempt was made to group the main studies and reviews about this topic Summary of the findings: LTA are more efficient than placebo and enhance the effects of inhaled corticosteroids. The association of inhaled corticosteroids with long-acting ß2 agonists is more efficient than the association of inhaled corticosteroids + LTA. Although use of LTA in acute asthma attacks and allergic rhinitis seems reasonable, more studies are needed to confirm this benefit. LTA reduce hospitalization time and the number of wheezing attacks in infants with acute viral bronchiolitis caused by respiratory syncytial virus, as well as recurrent wheezing after acute viral bronchiolitis. LTA are less efficient than intranasal corticosteroids for allergic rhinitis management. LTA are efficient in exercise-induced asthma, although they are not the first-line treatment. Conclusion:Controlled and randomized studies show that inhaled corticosteroids are the drugs of choice to treat persistent asthma and allergic rhinitis. There is not enough evidence to recommend the use of LTA as first-line drug (monotherapy) in children with asthma (level I). For children who cannot use inhaled corticosteroids, LTA may be a good alternative (level II).J Pediatr (Rio J). 2006;82(5 Suppl):S213-21: Asthma, exercise-induced asthma, rhinitis, antileukotrienes, montelukast, zafirlukast.

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“…Existem duas classes de leucotrienos: Cysteinil LT ou LT cisteínicos (Cys-LTs: LTC4, LTD4, LTE4) e LTB4, segundo a presença ou não de cisteína, respectivamente. Esses dois tipos de LT atuam através de dois receptores específicos distintos 13 . Por ação da enzima fosfolipase sobre os fosfolípides da membrana celular, ocorre uma cascata de formação de mediadores, como esquematizados na Figura 1.…”

Section: O Que São E Como Agem Os Leucotrienos (Lt) E Os Antagonistasunclassified

“…As ações dos Cys-LT nas estruturas das vias aéreas têm sido documentadas em numerosas investigações e incluem: potente broncoconstrição (muito maior do que a induzida pela histamina e metacolina), com conseqüentes alterações nos valores da função pulmonar, vasodilatação, aumento da secreção de muco, diminuição do transporte de muco e recrutamento de eosinófilos [13][14][15] .…”

Section: O Que São E Como Agem Os Leucotrienos (Lt) E Os Antagonistasunclassified

Antileukotrienes in the treatment of asthma and allergic rhinitis

Ribeiro¹,

Toro²,

Baracat³

2006

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Objective: To compare leukotriene antagonists (LTA) to other groups of drugs used in asthma and allergic rhinitis treatment.Sources: MEDLINE, LILACS and Cochrane Library. Keywords: leukotrienes, antileukotrienes, asthma treatment, allergic rhinitis treatment, asthma and allergic rhinitis. An attempt was made to group the main studies and reviews about this topic Summary of the findings: LTA are more efficient than placebo and enhance the effects of inhaled corticosteroids. The association of inhaled corticosteroids with long-acting ß2 agonists is more efficient than the association of inhaled corticosteroids + LTA. Although use of LTA in acute asthma attacks and allergic rhinitis seems reasonable, more studies are needed to confirm this benefit. LTA reduce hospitalization time and the number of wheezing attacks in infants with acute viral bronchiolitis caused by respiratory syncytial virus, as well as recurrent wheezing after acute viral bronchiolitis. LTA are less efficient than intranasal corticosteroids for allergic rhinitis management. LTA are efficient in exercise-induced asthma, although they are not the first-line treatment. Conclusion:Controlled and randomized studies show that inhaled corticosteroids are the drugs of choice to treat persistent asthma and allergic rhinitis. There is not enough evidence to recommend the use of LTA as first-line drug (monotherapy) in children with asthma (level I). For children who cannot use inhaled corticosteroids, LTA may be a good alternative (level II).J Pediatr (Rio J). 2006;82(5 Suppl):S213-21: Asthma, exerciseinduced asthma, rhinitis, antileukotrienes, montelukast, zafirlukast. ResumoObjetivo: Comparar os antagonistas de leucotrienos (ARLT) aos outros grupos de medicamentos utilizados para tratar a asma e a rinite alérgica.Fontes dos dados: MEDLINE, LILACS e Biblioteca Cochrane. Palavras chaves: leucotrienos, antileucotrienos, tratamento da asma, tratamento da rinite alérgica, asma e rinite alérgica. Procurou-se agrupar os principais trabalhos e revisões sobre o assunto.Síntese dos dados: Os ARLT são mais eficazes do que placebo e potencializam os efeitos dos corticosteróides inalados. A associação de corticosteróides inalados com agentes ß2-agonistas de longa duração (LABA) é mais eficaz do que a associação de cortiscoteróides inalados + ARLT. Embora pareça racional o uso de ARLT na crise aguda de asma e rinite alérgica, mais estudos são necessários para comprovar esse benefício. Os ARLT promovem redução no tempo de hospitalização e no número de crises de sibilância em lactentes com bronquiolite viral aguda pelo vírus respiratório sincicial e na sibilância recorrente após bronquiolite viral aguda. Os ARLT são menos eficazes que os corticosteróides intranasais no manejo da rinite alérgica. Os ARLT são eficazes na asma induzida por exercício (AIE), embora não constituam a primeira linha de tratamento. Conclusão:Estudos controlados e randomizados mostram que os corticosteróides inalados são as drogas de escolha para o tratamento da asma persistente e rinite a...

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Antileukotrienes in Upper Airway Inflammatory Diseases

Cingi

¹

,

Muluk

²

,

Ipci

³

et al. 2015

Curr Allergy Asthma Rep

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Leukotrienes (LTs) are a family of inflammatory mediators including LTA4, LTB4, LTC4, LTD4, and LTE4. By competitive binding to the cysteinyl LT1 (CysLT1) receptor, LT receptor antagonist drugs, such as montelukast, zafirlukast, and pranlukast, block the effects of CysLTs, improving the symptoms of some chronic respiratory diseases, particularly bronchial asthma and allergic rhinitis. We reviewed the efficacy of antileukotrienes in upper airway inflammatory diseases. An update on the use of antileukotrienes in upper airway diseases in children and adults is presented with a detailed literature survey. Data on LTs, antileukotrienes, and antileukotrienes in chronic rhinosinusitis and nasal polyps, asthma, and allergic rhinitis are presented. Antileukotriene drugs are classified into two groups: CysLT receptor antagonists (zafirlukast, pranlukast, and montelukast) and LT synthesis inhibitors (5-lipoxygenase inhibitors such as zileuton, ZD2138, Bay X 1005, and MK-0591). CysLTs have important proinflammatory and profibrotic effects that contribute to the extensive hyperplastic rhinosinusitis and nasal polyposis (NP) that characterise these disorders. Patients who receive zafirlukast or zileuton tend to show objective improvements in, or at least stabilisation of, NP. Montelukast treatment may lead to clinical subjective improvement in NP. Montelukast treatment after sinus surgery can lead to a significant reduction in eosinophilic cationic protein levels in serum, with a beneficial effect on nasal and pulmonary symptoms and less impact in NP. Combined inhaled corticosteroids and long-acting β-agonists treatments are most effective for preventing exacerbations among paediatric asthma patients. Treatments with medium- or high-dose inhaled corticosteroids, combined inhaled corticosteroids and LT receptor antagonists, and low-dose inhaled corticosteroids have been reported to be equally effective. Antileukotrienes have also been reported to be effective for allergic rhinitis.

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Montelukast in pediatric asthma management

Cited by 25 publications

References 47 publications

Antileucotrienos no tratamento da asma e rinite alérgica

Antileucotrienos no tratamento da asma e rinite alérgica

Antileukotrienes in the treatment of asthma and allergic rhinitis

Antileukotrienes in Upper Airway Inflammatory Diseases

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