Leukotriene receptor antagonists in the treatment of asthma

The role of leukotriene receptor antagonists in the treatment of persistent asthma is in evolution. Pivotal 8-12-week, randomized, controlled trials i n both adults and children have shown efficacy as defined by standard asthm a outcomes. Tolerance to therapy did not develop, nor did rebound worsening of asthma symptoms once therapy was withdrawn. In a comparator trial of mo ntelukast versus beclomethasone. the average percentage change from baselin e in forced expiratory volume in 1 second was greater with the inhaled cort icosteroid preparation; however, improvements in other asthma outcomes were similar. There was considerable heterogeneity of pulmonary response with b oth treatments, with good and poor responders in both groups. In an open-la bel, crossover comparison of montelukast versus cromolyn, both parents and children preferred montelukast, thus regimen adherence was greater with mon telukast. Additional long-term, randomized, controlled trials will define t he effectiveness of leukotriene receptor antagonists compared with establis hed controllers, thus determining the leukotriene receptor antagonists' pla ce in asthma management.