Tolerability Profiles of Leukotriene Receptor Antagonists and Long-Acting β₂-Adrenoceptor Agonists in Combination with Inhaled Corticosteroids for Treatment of Asthma: A Review

Abstract

Inhaled corticosteroids, long-acting beta2-adrenoceptor agonists, and leukotriene receptor antagonists are widely used for treatment of asthma. Inhaled corticosteroids are recommended as first-line therapy, whereas long-acting beta2-adrenoceptor agonists and leukotriene receptor antagonists are indicated as add-on therapy in patients not adequately controlled with corticosteroids alone. A number of studies have investigated the efficacy of combinations of these drugs in asthma, but several issues concerning the safety of these treatments are highly debated. This review provides a critical appraisal of the tolerability profiles of long-acting beta2-agonists and leukotriene receptor antagonists used in combination with inhaled corticosteroids for the treatment of asthma.

The Purinergic System as a Pharmacological Target for the Treatment of Immune-Mediated Inflammatory Diseases

“…Asthma is a chronic inflammatory disorder of the airways (Colucci et al, 2007). Clinically, asthma is characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and cough.…”

“…Clinically, asthma is characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and cough. Reversible airway obstruction, mucus overproduction, and bronchial hyperresponsiveness triggered by specific and nonspecific stimuli, such as allergens, chemical irritants, cold air, and exercise underlie the symptoms of asthma (Colucci et al, 2007). Mast cells, eosinophils, Th2 lymphocytes, group 2 innate lymphoid cell types, IgE-producing B lymphocytes, DCs, macrophages, and eosinophils are the key players of the type 2 immune response driving inflammation in asthma (Barnes, 2018).…”

Nitrosative events in atopic asthma pathogenesis

“…In the respiratory tract all isoforms have been identified [20,21]. cNOS-derived NO along with other NO adduct molecules are involved in maintaining normal metabolic functions, such as airway and pulmonary vascular tone, intracellular signaling, immunity (platelet aggregation, leukocyte adhesion) and neurotransmission [7,22]. By contrast to this, iNOSderived NO seems to play a pro-inflammatory primary role in the cytokine dependent processes [19].…”

“…Currently, the routine asthma treatment relies on suppressing the inflammation (glucocorticoids, leukotriene inhibitors as additional medication) as well as removal of bronchoconstriction (β agonists, anticholinergics) [6,7]. The symptom-based guidance of treatment could predispose to an increased num-ber of exacerbations.…”

4-CMTB Ameliorates Ovalbumin-Induced Allergic Asthma through FFA2 Activation in Mice

“…The airways of asthma patients often show infiltration of eosinophils, mucus overproduction, bronchial mucosal thickening, and bronchial wall remodeling (Pascual and Peters, 2005). Corticosteroids, long-acting β2-adrenoceptor agonists or leukotriene D4 antagonists are currently used to control the symptoms (Colucci et al, 2007). However, new anti-asthmatic drugs with novel action mechanism in addition to safety and efficacy are needed, considering steroid-induced side effects and steroid-resistant asthma patients (Barnes, 2013).…”