Leicestershire Health Community
3 Respiratory system
03-03-02 Leukotriene receptor antagonists
- Effective for some patients with asthma when used with an inhaled corticosteroid (Step 3 and above of the BTS Guidance). At Step 3 the preferred choice is a long acting beta-2 agonist (formoterol) followed by a trial of montelukast if control is not achieved.
- Montelukast has not been shown to be more effective than a standard dose of inhaled corticosteroid but the two drugs appear to have an additive effect.
- Leukotriene receptor antagonists may be of benefit in exercise-induced asthma and in those with concomitant rhinitis but they are less effective in those with severe asthma who are also receiving high doses of other drugs.
- A one-month trial of montelukast will be sufficient to assess effectiveness for most patients. If there is not a measurable improvement in objective outcomes after this time the treatment should be stopped.
- The Committee on Safety of Medicines (CSM) has advised that leukotriene receptor antagonists should not be used to relieve an attack of acute severe asthma and that their use does not necessarily allow a reduction in existing corticosteroid treatment.