The Cochrane Library and Leukotriene Receptor Antagonists for Children with Asthma: An Overview of Reviews

Background Asthma is a common childhood disease characterised by chronic inflammation of the airways. One treatment option is the class of medications known as the leukotriene receptor antagonists (LTRAs). The use of LTRA in combination with inhaled corticosteroid (ICS) may improve asthma control by reducing mucus secretion, inflammation and bronchoconstriction via this alternate pathway. Objectives To synthesise the evidence currently in The Cochrane Library Database Of Systematic Reviews (CDSR) related to the question, ‘In children with symptomatic but stable asthma, does treatment with a LTRA as a primary or add-on therapy to ICS improve objective measures of lung function and asthma symptom control, reduce exacerbations, and improve quality of life compared to standard care?’ Methods CDSR was searched using the term ‘asthma’ in the title for all systematic reviews examining anti-leukotriene agents vs any other pharmacological agent for the treatment of asthma. Data were extracted and entered into tables; data were synthesised using qualitative and quantitative methods. Main Results Three reviews were identified; however, only two reviews contained data in children. There was no significant difference in change in FEV1, number of missed school days, or the proportion of children requiring oral corticosteroid treatment, or proportion of children who experienced an asthma exacerbation requiring hospital admission among those randomised to LTRA vs ICS. The addition of LTRA treatment to ICS resulted in no significant difference in the change in FEV1 or morning PEFR, use of β2-agonist rescue medication, proportion of children admitted to the hospital due to an asthma exacerbation, or quality of life. Authors' Conclusions Until further evidence is available for children, LTRAs should not be substituted for ICS as monotherapy and ICS should remain the first line therapy for children with asthma. Currently, there is insufficient evidence to conclude that anti-leukotriene agents added to ICS therapy improves asthma control, steroid-sparing effect, or improved quality of life. Future research should address the gaps in children, including those as young as 2 years of age. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

[1]  T. Lasserson,et al.  Long-acting beta2-agonists versus anti-leukotrienes as add-on therapy to inhaled corticosteroids for chronic asthma. , 2006, The Cochrane database of systematic reviews.

[2]  L. Boulet,et al.  Summary of recommendations from the Canadian Asthma Consensus guidelines, 2003. , 2005, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[3]  J. Soriano,et al.  Asthma control in Latin America: the Asthma Insights and Reality in Latin America (AIRLA) survey. , 2005, Revista panamericana de salud publica = Pan American journal of public health.

[4]  D. Fabian,et al.  The global burden of asthma: executive summary of the GINA Dissemination Committee Report , 2004, Allergy.

[5]  N. Zhong,et al.  Asthma control in the Asia-Pacific region: the Asthma Insights and Reality in Asia-Pacific Study. , 2003, The Journal of allergy and clinical immunology.

[6]  P. Kuna,et al.  [Effect of triamcinolone acetonide, montelukast, nedocromil sodium and formoterol on eosinophil blood counts, ECP serum levels and clinical progression of asthma in children]. , 2002, Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego.

[7]  P. Kuna,et al.  A randomized, double‐blind trial of the effect of glucocorticoid, antileukotriene and bβ‐agonist treatment on IL‐10 serum levels in children with asthma , 2002, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[8]  F. Ducharme.  Addition of anti-leukotriene agents to inhaled corticosteroids for chronic asthma. , 2004, The Cochrane database of systematic reviews.

[9]  S. Pedersen,et al.  Do inhaled corticosteroids inhibit growth in children? , 2001, American journal of respiratory and critical care medicine.

[10]  F. Simons,et al.  Montelukast added to budesonide in children with persistent asthma: a randomized, double-blind, crossover study. , 2001, The Journal of pediatrics.

[11]  J. Leff,et al.  Oral Montelukast Versus Inhaled Beclomethasone in 6- to 11-year-old Children with Asthma: Results of an Open-label Extension Study Evaluating Long-term Safety, Satisfaction, and Adherence with Therapy , 2001, Current medical research and opinion.

[12]  N Franklin Adkinson,et al.  Long-term effects of budesonide or nedocromil in children with asthma. , 2000, The New England journal of medicine.

[13]  K. Carlsen,et al.  Asthma drug adherence in a long term clinical trial , 2000, Archives of disease in childhood.

[14]  Jilly F. Evans,et al.  Characterization of the human cysteinyl leukotriene CysLT1 receptor , 1999, Nature.

[15]  F. Simons,et al.  Benefits and risks of inhaled glucocorticoids in children with persistent asthma. , 1998, Journal of Allergy and Clinical Immunology.

[16]  S. Szefler,et al.  Dose-related efficacy of budesonide administered via a dry powder inhaler in the treatment of children with moderate to severe persistent asthma. , 1998, The Journal of pediatrics.

[17]  Richard Beasley,et al.  Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC , 1998, The Lancet.

[18]  F. Simons,et al.  A comparison of beclomethasone, salmeterol, and placebo in children with asthma. Canadian Beclomethasone Dipropionate-Salmeterol Xinafoate Study Group. , 1997, The New England journal of medicine.

[19]  G. Kollerup,et al.  Short-term growth and collagen turnover in asthmatic adolescents treated with the inhaled glucocorticoid budesonide , 1997, Steroids.

[20]  S. Weiss,et al.  Inhaled steroids and the risk of hospitalization for asthma. , 1997, JAMA.

[21]  W. Lenney,et al.  The burden of pediatric asthma , 1997, Pediatric pulmonology. Supplement.

[22]  R. Pauwels,et al.  GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION , 1996 .

[23]  G. Todd,et al.  Growth and adrenal suppression in asthmatic children treated with high-dose fluticasone propionate , 1996, The Lancet.

[24]  P. O'Byrne,et al.  Efficacy and Cost Benefit of Inhaled Corticosteroids in Patients Considered to Have Mild Asthma in Primary Care Practice , 1996 .

[25]  A. Kamada,et al.  Glucocorticoids and growth in asthmatic children , 1995, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[26]  S. Pedersen,et al.  Budesonide treatment of moderate and severe asthma in children: a dose-response study. , 1995, The Journal of allergy and clinical immunology.

[27]  A. Coates,et al.  Lung recoil and the determination of airflow limitation in cystic fibrosis and asthma , 1993, Pediatric pulmonology.

[28]  M. Phillip,et al.  Integrated plasma cortisol concentration in children with asthma receiving long‐term inhaled corticosteroids , 1992, Pediatric pulmonology.

[29]  P. Piper.  Leukotrienes and the airways. , 1989, European journal of anaesthesiology.

[30]  H. Bisgaard,et al.  Adrenal function in children with bronchial asthma treated with beclomethasone dipropionate or budesonide. , 1988, The Journal of allergy and clinical immunology.