Leukotrienes and the Latest Drug Treatments for Asthma

Sunday, August 2, 2009, 12:50
Asthma
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Andrew:: Dr. Ayars, maybe you can help decipher for us now what’s developing with treatments, and maybe the new class of treatments that people with asthma have heard about, the leukotrienes. What are they, and what do they mean to asthmatics? Maybe you could also tell me even including references about certain drugs that people are hearing about on TV, Accolate, Singulair, I think Zyflow. How do people assess all these drugs and where do they fit in with your armament for latest treatment in asthma?
Dr. Ayars:: You asked what leukotrienes are. They are chemicals that mediate inflammatory responses. And we do know now that asthma is an inflammatory disease where you get lots of inflammation of the lining of the lungs and the leukotrienes certainly play an important role in that process. And anything you can do to block the effect of leukotrienes hopefully will have a salutary effect on lung function and the patient will feel better. There are three new anti-leukotriene drugs out at this time, and you mentioned them, Accolate, Singulair and Zyflow. They have some anti-inflammatory effect. They’ve just been out about a year and there’s relatively little experience with them. They’re trying to pigeonhole themselves primarily for the treatment of mild asthma and that is basically where I am using it at this time. They are not as potent as the inhaled steroids as far as preventing the inflammatory response. They don’t have as many anti-inflammatory effects as steroids do, so they’re not as good generally, and usually in head-to-head competition with the inhaled steroids, they’re not as good. But, they can certainly play a role and be advantageous in the mild asthmatic. They are pills and some people prefer to take pills than use inhalers, and based on the current literature, they seem very safe in the vast majority of the patients. The other thing that’s attractive in using at least Singulair is it’s approved down to age 6 to 12 and above of course. And this population often is not very good at using inhalers, and the Singulair is just once-a-day dosing, so it’s very convenient, and it’s just a pill they can swallow. And if they have mild asthma, it may well be enough to control their symptoms. There is still somewhat, I feel, inappropriate fear about inhaled steroids in the younger populations. And certainly there are patients who are somewhat leery about taking inhaled steroids, and if the patient is a mild asthmatic, they may well do well with this type of drug and not be concerned about their fears of steroids.
Andrew:: It sounds to me like your range of treatments has expanded although, for moderate to severe asthma, the inhalers and the inhaled corticosteroids are really what you prefer?
Dr. Ayars:: I agree.

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