Uncontrolled asthma: is adjunct anti-leukotriene better than increased ICS dose?

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Takeaway
  • In adults and adolescents with uncontrolled asthma receiving daily inhaled corticosteroid (ICS), adding leukotriene receptor antagonist (LTRA) reduced exacerbation and improved lung function and control compared with same dose ICS alone. 
  • No evidence of superiority vs increased dose ICS.

Why this matters

  • LTRA+ICS is recommended by the Global Initiative for Asthma for patients aged ≥12 y with persistent uncontrolled asthma. 
  • 2004 Cochrane review found no benefit of adding LTRA vs same/increased ICS dose. 
  • Since that time, more evidence has been published. 
  • The current review determined available evidence does not support the use of LTRA as an ICS sparing agent.

Study design

  • Cochrane review identified 37 studies (6128 patients) in search on CENTRAL, MEDLINE, EMBASE, PsycINFO, and 4 other databases till August 2016.
  • Funding: National Institute for Health Research.

Key results

  • LTRA+ICS vs same dose ICS al...