NEW MODALITIES FOR THE PHARMACOTHERAPY OF ASTHMA: Leukotriene Inhibitors and Antagonists

Abstract

Although the reasons for the worldwide growth in asthma prevalence are multifactorial, the evidence suggests that the frequent inability to treat early and aggressively the underlying inflammation associated with the disease lies close to the heart of the matter. It may be a paradox of science that our therapeutic failure has followed a number of important new insights into asthma’s pathogenesis and natural history. Most significantly, we have begun to comprehend the critical role of asthma’s inflammatory component. We also have identified many of the critical cells and mediators that amplify the inflammatory response, and have developed new strategies to inhibit their activity. A central target of investigation has been the family of leukotrienes. Our expanding knowledge base, built on a new understanding of the basic science and clinical effects of these products, is significant for a number of reasons, not the least of which is the fact that the biochemical complex of reactions associated with the family of leukotrienes has both pathologic and therapeutic consequences. More specifically, there is good evidence that leukotriene pathway inhibitors and receptor antagonists may be of particular utility in the treatment of patients with aspirinintolerant or exercise-induced asthma. Further studies are required to determine the relative efficacy of these drugs compared with that of inhaled corticosteroids in patients with moderate asthma or in more severe patients requiring oral corticosteroids. Given the progress already made, it is likely that, in the near future, these new compounds will come to play an important role in the management of asthma around the world.