Anti-leukotriene therapy in asthma.

There is ample evidence that leukotrienes are important inflammatory mediators of asthma. Anti-leukotriene therapy is a novel, specific anti-asthma strategy providing both reliever and controller effects. Currently, two types of anti-leukotriene drugs are being registered in several countries: leukotriene receptor antagonists and leukotriene biosynthesis inhibitors. Both types of drugs have shown comparable bronchodilator effects, and provided protection against bronchoprovocation tests with cold dry air, exercise, allergen and aspirin. Moreover, beneficial effects have been shown in the treatment of day-to-day asthma resulting in improvement of clinical symptoms, lung function parameters, and a reduction in beta 2-agonist- and corticosteroid-use. Furthermore, some studies showed a decrease in the airway eosinophil counts after longterm administration of anti-leukotriene drugs, suggestive of anti-inflammatory effects. Because of these properties in combination with generally mild adverse effects, anti-leukotrienes seem promising in the treatment of patients with various types and severities of asthma, including children. However, their definitive place in the management of asthma will eventually depend on their effectiveness to modulate the chronic airway inflammation, which induces the structural changes within the airways, determining the severity of clinical symptoms of asthma.